Jaqueline Estevez, PharmD1, Roberto Simons-Linares, MD, MS2, Prabhleen Chahal, MD, FACG1
1Cleveland Clinic, Cleveland, OH; 2Cleveland Clinic Foundation, Cleveland, OH
Introduction: Hypertriglyceridemia (HTG) may impact acute pancreatitis (AP) outcomes. This study investigates the effect of different serum triglycerides (TG) thresholds on the development of persistent or multiple organ failures in patients with AP.
Methods: Cohort study of a prospectively maintained database of patients admitted with AP at a tertiary center in the last 15 years. We strictly included patients who met AP diagnosis by Revised Atlanta Classification. Severity of HTG was determined by the American Endocrine Society guidelines. Control group: AP (including all common etiologies, except HTG-induced AP). Study groups included other common HTG scenarios: 1) HTG-AP (i.e. HTG-induced AP), 2) HTG-AP + DKA (i.e. Triad), and 3) AP + diabetes ketoacidosis (AP-DKA). We assessed the levels of TG and its impact on organ failure. Multivariable logistic regression models were constructed using STATA software version 9.4
Results: 2,654 patients were reviewed, of whom 124 patients had the triad (HTG-AP, DKA), 100 had HTG-AP only (triglyceride levels >1,000 mg/dL), 67 had AP +DKA and we included 101 with AP-only as control for the analysis. Overall, any level of hypertriglyceridemia in all of the three study groups (HTG related syndromes) had higher odds for developing organ failure when compared to the control group (table 1). All study groups had higher odds to develop ARDS, AKI, ileus, and shock. The highest odds ratios for organ failures were: HTG-AP patients with moderate levels of HTG were almost 25 times more likely to develop ARDS. AP-DKA patients with moderate levels of HTG were 32 times more likely to develop AKI. HTG-AP patients with severe HTG levels were 16 times more likely to develop ileus. HTG-AP patients with moderate HTG levels were 7 times more likely to develop shock. Interestingly, all study groups had lower odds to develop SIRS, persistent SIRS at 24 or48 hrs., and myocardial infarction (MI) (table 1).
Discussion: Increased TG levels were associated with the development of multiple organ failure among AP patients, particularly in the settings of HTG-induced AP, the Triad of HTG-AP-DKA, and AP-DKA. Interestingly, HTG did not correlate with SIRS (transient or persistent), which one could have expected. It seems that the severe organ failure is driven by direct lipotoxicity from HTG rather than pancreatitis-inflammation (i.e. SIRS).
Citation: Jaqueline Estevez, PharmD; Roberto Simons-Linares, MD, MS; Prabhleen Chahal, MD, FACG. P0020 - ASSESSMENT OF THE IMPACT OF HYPERTRIGLYCERIDEMIA ON ORGAN FAILURE DURING ACUTE PANCREATITIS: A DIFFERENT PERSPECTIVE. Program No. P0020. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.