Incidence and Outcome of HTG-AP at a Tertiary Care Center in Eastern India: A Retrospective Analysis

Hypertriglyceridemia-associated pancreatitis (HTG-AP) is a notable cause of acute pancreatitis (AP) due to high triglyceride (TG) levels. It is associated with more complications than non-hypertriglyceridemia-associated acute pancreatitis (non-HTG AP). Current treatments include supportive care, insulin infusion, and plasmapheresis. Improved guidelines and protocols are needed due to the complex nature and rarity of the condition. The current study was conducted because of the paucity of data available for HTG-AP from India.

The study retrospectively analyzed data of adult HTG-AP patients hospitalized at a tertiary care facility in Eastern India from August 2021 to August 2024. Acute pancreatitis was classified per modified Atlanta criteria, with HTG-AP defined as AP associated with a serum TG > 1000 mg/dL. The primary outcome was a > 50% decline in TG level from the baseline. Secondary outcomes included complete cessation of insulin therapy once the TG level < 500 mg/dL, adverse events, and in-hospital mortality.

Twenty-four patients had HTG-AP (median age: 38.5 years; 87.5% male), accounting for 5.7% of all AP admissions. Diabetes and alcohol use were each present in 62.5% of cases. About 62.5% of patients had moderately severe to severe AP, which was significantly higher than non-HTG-AP cases. Necrotizing pancreatitis was observed in 45.8% of patients. Insulin therapy reduced TG levels by more than 50% in 45.83%, 87.5%, and 91.67% of the patients at 24, 48, and 72 hours, respectively. Insulin therapy could be stopped in 25%, 62.5%, and 83.3% of the patients at 24, 48, and 72 hours, respectively. Only one patient had symptomatic hypoglycemia, which was managed with a dextrose bolus. In-hospital mortality was seen in 12.5% of the cases.

About 5.7% of the Indian patients admitted with AP had HTG-AP, with about two-thirds having non-mild AP. Insulin infusion was the primary treatment for lowering serum TG levels in most patients with HTG-AP, with a fourth to a fifth of the patients achieving control of their TG levels.

Giri S, Singh RK, Jena SK, et al. Incidence and Outcome of HTG-AP at a Tertiary Care Center in Eastern India: A Retrospective Analysis. Euroasian J Hepato-Gastroenterol 2025;15(1):50-53.