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Hypertriglyceridaemia-Induced Acute Pancreatitis: A Different Disease Phenotype
Greta Dancu1, Felix Bende1, Mirela Danila1
1Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania.
Insights
Severe hypertriglyceridaemia-induced acute pancreatitis (HTGAP) presents a higher complication rate than other causes. Blood urea nitrogen (BUN) and hematocrit (HT) at 48 hours are key predictors of severity in HTGAP patients.
Area of Science:
- Gastroenterology and Hepatology
- Internal Medicine
- Biomarker Discovery
Background:
- Acute pancreatitis (AP) is a leading cause of hospitalization.
- Severe hypertriglyceridaemia (HTG) is a significant, yet less common, etiology of AP (HTGAP).
- HTGAP is suspected to have higher complication and severity rates compared to non-HTGAP.
Purpose of the Study:
- To compare complication rates between HTGAP and non-HTGAP.
- To identify predictive biomarkers for severe AP in HTGAP patients.
Main Methods:
- Retrospective study of 262 AP patients.
- Patients categorized into HTGAP (11%) and non-HTGAP groups.
- Analysis of demographic data, comorbidities (diabetes mellitus), disease severity, complications, biomarkers (CRP, hematocrit, BUN), hospital stay, and mortality.
Main Results:
- HTGAP patients were younger (44.4 vs. 58.2 years) and had higher rates of diabetes mellitus (53% vs. 18%).
- HTGAP showed a more severe inflammatory response (higher CRP at 48h) and a trend towards more local complications.
- Hematocrit (HT) and blood urea nitrogen (BUN) at 48 hours demonstrated high predictive value (AUC > 0.8) for severe AP; BUN at 48h was an independent predictor.
Conclusions:
- HTGAP is associated with a more severe inflammatory profile and potentially higher rates of local complications compared to non-HTGAP.
- BUN and hematocrit levels at 48 hours post-admission are valuable predictive markers for severe AP in the context of HTG.
- Further research is warranted to elucidate the specific mechanisms driving HTGAP severity and to optimize management strategies.
Abstract:
Acute pancreatitis (AP) is the most common gastrointestinal indication requiring hospitalisation. Severe hypertriglyceridaemia (HTG) is the third most common aetiology of AP (HTGAP), with a complication rate and severity that are higher than those of other aetiologies (non-HTGAP). The aim of this study was to evaluate the supposedly higher complication rate of HTGAP compared to non-HTGAP. The secondary objectives were to find different biomarkers for predicting a severe form. This was a retrospective study that included patients admitted with AP in a tertiary department of gastroenterology and hepatology. The patients were divided into two groups: HTGAP and non-HTGAP. We searched for differences regarding age, gender, the presence of diabetes mellitus (DM), the severity of the disease, the types of complications and predictive biomarkers for severity, hospital stay and mortality. A total of 262 patients were included, and 11% (30/262) of the patients had HTGAP. The mean ages were 44.4 ± 9.2 in the HTGAP group and 58.2 ± 17.1 in the non-HTGAP group, p < 0.0001. Male gender was predominant in both groups, at 76% (23/30) in the HTGAP group vs. 54% (126/232) in non-HTGAP, p = 0.02; 53% (16/30) presented with DM vs. 18% (42/232), p < 0.0001. The patients with HTG presented higher CRP 48 h after admission: 207 mg/dL ± 3 mg/dL vs. non-HTGAP 103 mg/dL ± 107 mg/dL, p < 0.0001. Among the patients with HTGAP, there were 60% (18/30) with moderately severe forms vs. 30% (71/232), p = 0.001, and 16% (5/30) SAP vs. 11% (27/232) in non-HTGAP, p = 0.4 Among the predictive markers, only haematocrit (HT) and blood urea nitrogen (BUN) had AUCs > 0.8. According to a multiple regression analysis, only BUN 48 h was independently associated with the development of SAP (p = 0.05). Diabetes mellitus increased the risk of developing severe acute pancreatitis (OR: 1.3; 95% CI: 0.1963−9.7682; p = 0.7). In our cohort, HTGAP more frequently had local complications compared with non-HTGAP. A more severe inflammatory syndrome seemed to be associated with this aetiology; the best predictive markers for complicated forms of HTGAP were BUN 48 h and HT 48 h.
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