P1050 - Severe Hypertriglyceridemia Is Associated With Increased Risk of Necrosis in Patients With Hypertriglyceridemia-Induced Pancreatitis

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

CL

Chang Li, MD

University of Texas Health Science Center at Houston
Houston, TX, United States

Victor Garcia-Rodriguez, MD, Chang Li, MD, Yllen Hernandez-Blanco, MD, Gabriel Aisenberg, MD, Liang Zhu, PhD, Rosa Estrada-Y-Martin, MD, Sujith Cherian, MD
University of Texas Health Science Center at Houston, Houston, TX

Introduction: Hypertriglyceridemia represents the third most common cause of acute pancreatitis (AP) after gallstones and alcohol. High triglyceride (TG) levels have been shown as a risk factor for severe pancreatitis and organ failure. Additionally, necrotizing pancreatitis has been reported in nearly 20% of the cases of hypertriglyceridemia induced acute pancreatitis (HTG-AP). The aim of this study was to assess the clinical features and outcomes in patients with HTG-AP based on different levels of serum triglycerides.

Methods: Retrospective single-center study of patients admitted with HTG-AP from 2010-2019. Patients were included based on the criteria of age 18 and over, TG levels above 500 mg/dl, and the diagnosis of AP. TG levels were measured at the time of admission. Computed tomography (CT) reports were reviewed and classified according to the CT severity index score for acute pancreatitis. Cochran-Armitage trend test was used to evaluate if there is an increasing trend in the proportion of necrosis due to increasing serum triglyceride levels.

Results: Of the 101 analyzed patients, 12 (11.8%) had tomographic evidence consistent with pancreatic necrosis. 12 patients did not have a CT of the abdomen. Table 1 compares the clinical characteristics and outcomes of patients with and without tomographic evidence of necrosis. Both groups were similar in terms of age, ethnicity, alcohol use, and presence of other comorbidities. There were no differences in BISAP score at admission and Ranson’s score at 48 hours. Length of stay and number of ICU admissions were similar between the two groups. In comparison to patients with interstitial edematous HTG-AP, patients with necrotizing HTG-AP had higher incidence of acute kidney injury (p=0.02), thrombosis (p=0.03), and pleural effusion (p=0.02). TG levels were found to be higher in the necrotizing HTG-AP group (p=0.0065). Moreover, the risk of necrosis increases significantly with increased TG levels.

Discussion: In our cohort the incidence of necrotizing pancreatitis was similar to prior studies. We demonstrated a statistically significant relationship between the levels of triglycerides and the incidence of pancreatic necrosis, which is also associated with complications such as acute kidney injury, thrombosis, and pleural effusion. Given the demographic and a relatively small size of study population, these findings should be confirmed in a larger population to further help characterize TG levels and complications associated with AP.

	Necrosis, n=12	No necrosis, n=77	P value
Gender, male; n (%)	12 (100)	77 (100)	1.00
Age, years ± sd	35 ± 10	38 ± 9	0.76
Ethnicity
Hispanic; n (%)	12 (100)	64 (83)	0.20
African American; n (%)	0 (0)	8 (10)	0.59
Caucasian; n (%)	0 (0)	3 (4)	1.00
Other; n (%)	0 (0)	2 (3)	1.00
Comorbid conditions
Diabetes mellitus; n (%)	9 (75)	56 (73)	1.00
Hgb A1c; % ± sd	9 ± 3	10 ± 3	0.32
Obesity; n (%)	8 (67)	35 (45)	0.22
BMI; kg/m² ± sd	32 ± 5	30 ± 6	0.44
Fatty liver disease; n (%)	2 (17)	24 (31)	0.50
Alcohol abuse; n (%)	8 (67)	42 (55)	0.54
Previous pancreatitis; n (%)	8 (67)	33 (43)	0.21
Serum triglyceride levels, mg/dL ± sd	2013 ± 2231	1507 ± 1591	0.0065
BISAP score; n ± sd	1 ± 1	1 ± 1	0.06
Ranson’s score at 48 hs; n ± sd	3 ± 1	3 ± 2	0.55
Hospital length of stay; days ± sd	7 ± 5	5 ± 7	0.51
Admitted to ICU; n (%)	7 (58)	33 (43)	0.36
ICU length of stay; days ± sd	6 ± 3	3 ± 5	0.37
Treatment received
Insulin; n (%)	10 (83)	50 (65)	0.32
Fibrates; n (%)	8 (67)	59 (77)	0.48
Complications
Acute kidney injury; n (%)	6 (50)	13 (17)	0.02
ARDS; n (%)	1 (8)	1 (1)	0.25
Ascites; n (%)	4 (33)	8 (10)	0.05
Thrombosis; n (%)	3 (25)	3 (4)	0.03
SIRS; n (%)	11 (92)	54 (70)	0.17
Pleural effusion; n (%)	5 (42)	9 (12)	0.02
Mortality; n (%)	1 (8)	0 (0)	0.13

Table: Table 1. Demographic, clinical presentation, and outcomes among patients with HTG-AP based on presence of necrosis at presentation.
SD=standard deviation; IQR=interquartile range; BISAP=Bedside index for severity in acute pancreatitis; ARDS=adult respiratory distress syndrome; SIRS=systemic inflammatory response syndrome; APFC= acute peripancreatic fluid collection; ANC=acute necrotic collection; WONfwalled-off necrosis; CT=computed tomography; ICU=intensive care unit.

Disclosures:

Victor Garcia-Rodriguez indicated no relevant financial relationships.

Chang Li indicated no relevant financial relationships.

Yllen Hernandez-Blanco indicated no relevant financial relationships.

Gabriel Aisenberg indicated no relevant financial relationships.

Liang Zhu indicated no relevant financial relationships.

Rosa Estrada-Y-Martin indicated no relevant financial relationships.

Sujith Cherian indicated no relevant financial relationships.

Victor Garcia-Rodriguez, MD, Chang Li, MD, Yllen Hernandez-Blanco, MD, Gabriel Aisenberg, MD, Liang Zhu, PhD, Rosa Estrada-Y-Martin, MD, Sujith Cherian, MD. P1050 - Severe Hypertriglyceridemia Is Associated With Increased Risk of Necrosis in Patients With Hypertriglyceridemia-Induced Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.