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Hypertriglyceridemia Screening in Acute Pancreatitis: Diagnostic Blind Spot in Clinical Routine
Mohamad Amer Nashtar1, Jan Kempener1, Uttban Gohman1
1Section of Cardiology, Angiology and Internal Emergency Medicine, Department of Internal Medicine, Knappschaft Kliniken-University Hospital Bochum, Ruhr University Bochum, Bochum, Germany.
Background:
Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP) after gallstones and alcohol abuse. Early determination of the triglyceride (TG) level in patients with acute abdominal pain, particularly in cases of AP, is crucial, as an acute increase can be followed by a rapid decrease within 2 days. HTG as a cause of acute abdominal pain and AP is often overlooked in clinical practice. In addition, manifest HTG is often underdiagnosed and inadequately treated.
Methods:
We investigated 1279 cases of acute abdominal pain, including 226 cases of AP, to assess the frequency and timing of TG level measurement. Additionally, we studied 237 patients with HTG levels above 500 mg/dL to determine the frequency of HTG-related symptoms and the rate of initiation of adequate therapy, considering the specialty in which the elevated TG levels were identified.
Results:
Triglycerides were determined in 22% of patients with acute abdominal pain and 55% with AP; fewer than 15% of all patients received a determination at the first contact with the physician. TG levels were measured at a median of 24 h (1-54) in patients with acute abdominal pain and 48 h (24-95) in those with AP after admission. Less than half of patients with HTG received TG-lowering therapy. Only 5 of 226 cases with AP was identified as HTG-induced, while 13.5% of all cases with HTG above 500 mg/dL had a history of AP.
Conclusions:
Our findings support the assumption that HTG and its complications are often underestimated in clinical practice and require more attention. Furthermore, early initiation of appropriate therapy is crucial.
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