[A comparative study of coagulation function and disease severity between hyperlipidemic acute pancreatitis and...

To compare coagulation function and disease severity between hyperlipidemic acute pancreatitis (HLAP) and biliary acute pancreatitis (BAP), and assess the relationship between coagulation disorder and disease severity.

A retrospective cohort study was conducted. Patients diagnosed with HLAP and BAP who were admitted to the department of infectious diseases and intensive care medicine of Beijing Friendship Hospital of Capital Medical University from January 2018 to February 2023 were enrolled. Clinical data and laboratory indicators were collected, and evaluate their coagulation function through prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), antithrombin- III (AT- III), fibrinogen degradation products (FDP), fibrinogen (Fbg), D-dimer, and disseminated intravascular coagulation (DIC) score; the severity of the disease was measured by the sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II), modified Marshall score, and CT severity index (CTSI) score. According to the modified Atlanta criteria, patients were classified into mild acute pancreatitis (MAP), moderate severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). Logistic regression analysis was performed to evaluate the relationship between coagulation disorder and disease severity.

A total of 204 patients with BAP (MAP 70, MSAP 64, SAP 70) and 98 patients with HLAP (MAP 25, MSAP 35, SAP 38) were included. In patients with MAP, HLAP patients had significantly higher Fbg level and CTSI score compared with BAP patients [Fbg (g/L): 5.83 (3.59, 6.83) vs. 3.47 (2.70, 4.28), CTSI score: 2.00 (1.50, 2.50) vs. 1.50 (0.00, 2.00), both P < 0.05]. In patients with MSAP, the levels of Fbg and D-dimer in HLAP were significantly higher than those in BAP [Fbg (g/L): 6.42 (4.66, 7.31) vs. 3.55 (2.96, 5.09), D-dimer (mg/L): 2.10 (1.40, 5.20) vs. 1.30 (0.81, 2.28), both P < 0.05]. In patients with SAP, HLAP patients had significantly higher levels of Fbg, FDP, D-dimer, and DIC score, APACHE II score, CTSI score, and modified Marshall score compared with BAP patients [Fbg (g/L): 6.28 (4.67, 7.79) vs. 3.88 (2.87, 6.28), FDP (mg/L): 21.34 (12.70, 29.86) vs. 12.13 (5.65, 21.30), D-dimer (mg/L): 6.54 (4.35, 9.15) vs. 3.89 (1.58, 6.23), DIC score: 3.00 (3.00, 3.00) vs. 2.00 (2.00, 3.00), APACHE II score: 11.00 (7.75, 16.25) vs. 8.00 (5.75, 12.00), CTSI score: 4.00 (2.00, 4.75) vs. 2.00 (1.00, 4.00), modified Marshall score: 2.00 (1.00, 3.00) vs. 1.00 (1.00, 2.00), all P < 0.05]. Logistic regression analysis demonstrated that the DIC score as a factor affecting the severity of acute pancreatitis [odds ratio (OR) = 1.32, 95% confidence interval (95%CI) was 1.01-1.54, P = 0.040], FDP level also as a factor affecting the severity of acute pancreatitis (OR = 1.08, 95%CI was 1.05-1.11, P < 0.001).

Patients with HLAP exhibited more severe coagulation disorders and clinical courses than those with BAP, and coagulation disorders were associated with disease severity in acute pancreatitis.