Highlights
- •Hypertriglyceridemia-induced acute pancreatitis recurrence rate is high.
- •High triglyceride (TG) level post attack is closely associated with recurrence.
- •Controlling TG below 5.65 mmol/L may be an effective strategy to prevent recurrence.
- •Glucose should be controlled below 7.0 mmol/L for preventing recurrence.
- •Long-term TG lowering drugs treatment decreases recurrence.
Background
Data on recurrent hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are scarce.
Objective
To investigate the incidence and risk factors for recurrence of HTG-AP, and the effect
of triglyceride (TG) lowering drugs post index attack on recurrence.
Methods
This study was a prospective cohort study of adult patients with first episode of
HTG-AP from December 2019 to February 2021 who were followed until recurrence or death,
or February 2022. The cumulative incidence function and Fine and Gray's competing-risk
model were applied to the analyses.
Results
A total of 317 patients were enrolled, and the 12-month and 18-month cumulative recurrence
incidences were 8% and 22%, respectively. The cumulative recurrence incidence was
2 times higher in patients whose serum TG levels post index attack were ≥5.65 mmol/L
(subdistribution hazard ratio [SHR], 2.00; 95% confidence interval [CI], 1.05–3.80;
P = 0.034) compared to patients with TG <5.65 mmol/L. The recurrence rate was 3.3 times
higher in patients whose glucose levels post index attack were ≥7.0 mmol/L (SHR, 3.31;
95% CI, 1.56–7.03; P = 0.002) than in patients with glucose <7.0 mmol/L). Compared to TG lowering drugs
for less than 1 month post index attack, treatment for longer than 12 months decreased
the incidence of recurrence by 75% (SHR, 0.25; 95% CI, 0.08–0.80; P = 0.019).
Conclusions
The HTG-AP recurrence incidence is high and closely associated with high levels of
TGs and glucose post index attack. Long-term TG lowering drugs treatment significantly
decreases this recurrence.
Keywords
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References
- Worldwide variations in demographics, management, and outcomes of acute pancreatitis.Clin Gastroenterol Hepatol. 2020; 18 (e2): 1567-1575https://doi.org/10.1016/j.cgh.2019.11.017
- A study on the etiology, severity, and mortality of 3260 patients with acute pancreatitis according to the revised Atlanta classification in Jiangxi, China over an 8-year period.Pancreas. 2017; 46: 504-509https://doi.org/10.1097/MPA.0000000000000776
- Prevalence, severity and management of hypertriglyceridemia-associated pancreatitis; A 7-year retrospective cohort study at Canadian quaternary care hospitals.J Clin Lipidol. 2022; 16: 455-462https://doi.org/10.1016/j.jacl.2022.05.064
- Clinical profile and natural course in a large cohort of patients with hypertriglyceridemia and pancreatitis.J Clin Gastroenterol. 2017; 51: 77-85https://doi.org/10.1097/MCG.0000000000000579
- Severe hypertriglyceridemia-related pancreatitis: characteristics and predictors of recurrence.Pancreas. 2019; 48: 182-186https://doi.org/10.1097/MPA.0000000000001235
- Clinical features of recurrent acute pancreatitis: experience from a single center.Pancreas. 2017; 46: e36-ee7https://doi.org/10.1097/MPA.0000000000000822
- Global epidemiology and holistic prevention of pancreatitis.Nat Rev Gastroenterol Hepatol. 2019; 16: 175-184https://doi.org/10.1038/s41575-018-0087-5
- Recurrent acute pancreatitis significantly reduces quality of life even in the absence of overt chronic pancreatitis.Am J Gastroenterol. 2018; 113: 906-912https://doi.org/10.1038/s41395-018-0087-7
- Management of hypertriglyceridemia.BMJ. 2020; 371: m3109https://doi.org/10.1136/bmj.m3109
- Rare variants in triglycerides-related genes increase pancreatitis risk in multifactorial chylomicronemia syndrome.J Clin Endocrinol Metab. 2021; 106: e3473-e3e82https://doi.org/10.1210/clinem/dgab360
- Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis.JAMA Intern Med. 2016; 176: 1834-1842https://doi.org/10.1001/jamainternmed.2016.6875
- Impact of cigarette smoking on recurrence of hyperlipidemic acute pancreatitis.World J Gastroenterol. 2017; 23: 8387-8394https://doi.org/10.3748/wjg.v23.i47.8387
- The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis.Lipids Health Dis. 2021; 20: 72https://doi.org/10.1186/s12944-021-01488-8
- Genetic variants associated with increased plasma levels of triglycerides, via effects on the lipoprotein lipase pathway, increase risk of acute pancreatitis.Clin Gastroenterol Hepatol. 2021; 19 (e6): 1652-1660https://doi.org/10.1016/j.cgh.2020.08.016
- Influence of Ambulatory Triglyceride Levels on Risk of Recurrence in Patients with Hypertriglyceridemic Pancreatitis.Dig Dis Sci. 2019; 64: 890-897https://doi.org/10.1007/s10620-018-5226-x
- 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation. 2019; 139: e1082-e1143https://doi.org/10.1161/CIR.0000000000000625
- Endocrine society. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab. 2012; 97: 2969-2989https://doi.org/10.1210/jc.2011-3213
- ESC Scientific Document Group. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias.Eur Heart J. 2016; 37: 2999-3058https://doi.org/10.1093/eurheartj/ehw272
- Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus.Gut. 2013; 62: 102-111https://doi.org/10.1136/gutjnl-2012-302779
- Assessment of computed tomography-defined muscle and adipose tissue features in relation to length of hospital stay and recurrence of hypertriglyceridemic pancreatitis.Int J Gen Med. 2021; 14: 1709-1717https://doi.org/10.2147/IJGM.S311118
- Recurrent acute pancreatitis: international state-of-the-science conference with recommendations.Pancreas. 2018; 47: 653-666https://doi.org/10.1097/MPA.0000000000001053
- American College of Gastroenterology guideline: management of acute pancreatitis.Am J Gastroenterol. 2013; 108 (1416): 1400-1415https://doi.org/10.1038/ajg.2013.218
- Long-term follow-up of patients with acute hypertriglyceridemia-induced pancreatitis.J Clin Gastroenterol. 2002; 34: 472-475https://doi.org/10.1097/00004836-200204000-00020
- Incidence of pancreatitis, secondary causes, and treatment of patients referred to a specialty lipid clinic with severe hypertriglyceridemia: a retrospective cohort study.Lipids Health Dis. 2011; 10: 157https://doi.org/10.1186/1476-511X-10-157
- Lipid-modifying therapies and risk of pancreatitis: a meta-analysis.JAMA. 2012; 308: 804-811https://doi.org/10.1001/jama.2012.8439
- Identification of a novel LPL nonsense variant and further insights into the complex etiology and expression of hypertriglyceridemia-induced acute pancreatitis.Lipids Health Dis. 2020; 19: 63https://doi.org/10.1186/s12944-020-01249-z
- Gene-environment interaction between APOA5 c.553G>T and pregnancy in hypertriglyceridemia-induced acute pancreatitis.J Clin Lipidol. 2020; 14: 498-506https://doi.org/10.1016/j.jacl.2020.05.003
Article info
Publication history
Published online: November 23, 2022
Accepted:
November 9,
2022
Received:
July 21,
2022
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of National Lipid Association.
