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Impact of Elevated Serum Triglycerides on Children with Acute Recurrent or Chronic Pancreatitis from INSPPIRE-2
Zachary M Sellers1, Matthew J Giefer2, Fuchenchu Wang3
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA.
Insights
Mild-moderate hypertriglyceridemia (HTG) in children with pancreatitis did not increase pancreatitis attacks or chronic pancreatitis (CP) development. However, HTG was linked to more complications and a higher disease burden, suggesting treatment may reduce these issues.
Area of Science:
- Pediatric Gastroenterology
- Metabolic Disorders
- Pancreatic Diseases
Background:
- Hypertriglyceridemia (HTG) is a metabolic condition characterized by elevated triglyceride levels.
- The association between mild-moderate HTG and the progression of pancreatitis in pediatric patients remains incompletely understood.
- Acute recurrent pancreatitis and chronic pancreatitis (CP) significantly impact children's health and quality of life.
Purpose of the Study:
- To investigate the relationship between mild-moderate hypertriglyceridemia (HTG) and the development of chronic pancreatitis (CP) or its complications in children.
- To assess whether HTG influences the frequency of pancreatitis attacks and the overall disease burden in pediatric patients with acute recurrent or CP.
Main Methods:
- Analysis of longitudinal data from the INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2) cohort.
- Classification of pediatric patients (n=559) into groups based on highest serum triglyceride levels: normal, any HTG, mild-moderate HTG, moderate HTG, and severe HTG.
- Evaluation of laboratory results, imaging findings, pancreatitis events, hospitalizations, complications, and quality of life metrics.
Main Results:
- No increased pancreatitis attacks per person-years or CP prevalence was observed in children with HTG.
- Severity of HTG correlated with increased pancreatic inflammation and pancreatic cysts.
- HTG was associated with a higher incidence of pain, extended hospital days, more hospitalizations, intensive care unit admissions, and missed school days.
Conclusions:
- Mild-moderate HTG in children with acute recurrent or CP does not elevate pancreatitis frequency or CP development.
- HTG is linked to increased pancreatitis complications and a greater disease burden in pediatric patients.
- Treating mild-moderate HTG may be beneficial in reducing pancreatitis-associated complications and the overall medical burden in children with acute recurrent or CP.
Objective:
To determine if mild-moderate hypertriglyceridemia (HTG) is associated with increased development of chronic pancreatitis (CP) or pancreatitis-associated complications in children with acute recurrent or CP.
Study Design:
Longitudinal data from the INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2) cohort of children with acute recurrent or CP (n = 559) were analyzed. Subjects were divided into normal triglycerides (<150 mg/dL; 1.7 mmol/L), any HTG (≥150 mg/dL; ≥1.7 mmol/L), mild-moderate HTG (150-499 mg/dL; 1.7-5.6 mmol/L), moderate HTG (500-999 mg/dL; 5.6-11.3 mmol/L), and severe HTG groups (≥1000 mg/dL; ≥11.3 mmol/L), based on highest serum triglyceride value. Laboratory, imaging, pancreatitis and hospital events, complications, and quality of life data were analyzed.
Results:
In children with acute recurrent or CP and HTG, there was no increase in the number of pancreatitis attacks per person-years, nor an increase in CP prevalence. However, HTG severity was associated with increased pancreatic inflammation, pancreatic cysts, pain, hospital days, number of hospitalizations, intensive care, and missed school days.
Conclusions:
Mild-moderate HTG in children with acute recurrent or CP was not associated with increased pancreatitis frequency, nor increased development of CP, but was associated with increased pancreatitis complications and disease burden. As a treatable condition, treatment of mild-moderate HTG may be considered to reduce pancreatitis-associated complications and medical burden in children with acute recurrent or CP.
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