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Recurrence for patients with first episode of hypertriglyceridemia-induced acute pancreatitis: A prospective cohort study

  • Author Footnotes
    1 These authors share co-first authorship.
    Ling Ding
    Footnotes
    1 These authors share co-first authorship.
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Author Footnotes
    1 These authors share co-first authorship.
    Langyi Guan
    Footnotes
    1 These authors share co-first authorship.
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Xueyang Li
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Xin Xu
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Yaoyu Zou
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Cong He
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Yi Hu
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Jianhua Wan
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Xin Huang
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Yupeng Lei
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Wenhua He
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Liang Xia
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Huifang Xiong
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Lingyu Luo
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Nonghua Lu
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Yin Zhu
    Correspondence
    Corresponding author.
    Affiliations
    Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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  • Author Footnotes
    1 These authors share co-first authorship.
Published:November 23, 2022DOI:https://doi.org/10.1016/j.jacl.2022.11.006

      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 enroled, 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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