Impact of early triglyceride reduction on clinical outcomes in patients with extremely severe hypertriglyceridemia-induced acute pancreatitis
10.3760/cma.j.cn115667-20241101-00183
- VernacularTitle:早期降脂达标对极重度高三酰甘油血症急性胰腺炎患者临床预后的影响
- Author:
Zirui LIU
1
;
Lin GAO
1
;
Lu KE
1
;
Weiqin LI
1
Author Information
1. 中国人民解放军东部战区总医院（南京大学医学院附属金陵医院重症医学科），南京 210002
- Publication Type:Journal Article
- Keywords:
Acute pancreatitis, hypertriglyceridemia;
Multiple organ failure;
Plasma exchange;
Prognosis
- From:
Chinese Journal of Pancreatology
2025;25(1):6-13
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the association between early reduction (within 3 days of admission) of serum triglyceride (TG) to 5.65 mmol/L and clinical outcomes in patients with acute pancreatitis extremely severe hypertriglyceridemia-induced (HTG-AP).Methods:The clinical data were derived from the PERFORM database, which prospectively collected clinical information on 613 HTG-AP patients admitted to 38 medical centers across China between November 2020 and June 2023 with serum TG level ≥11.3 mmol/L at admission. This study further screened extremely severe HTG patients with TG≥22.6 mmol/L. Patients were divided into the target-reaching group (TG≤5.65 mmol/L on day 3 after admission) and non-target-reaching group (TG>5.65 mmol/L on day3 after admission). The effect of early reduction of serum triglyceride to standard level on organ failure was observed. The primary outcome was organ failure-free days (OFFD) to 14 days of admission. Secondary outcomes included the presence of organ failure on day 7 and day 14, persistent organ failure (POF) to day 14, new-onset organ failure to day 14, maximum sequential organ failure assessment (SOFA) score to day 14, incidence of infected pancreatic necrosis (IPN) by day 60 of admission, length of ICU and hospital stay, mortality by day 60 of admission. The linear regression model was used for multivariate analysis. The subgroup forest plot was drawn to assess the effect of early reduction of TG on OFFD in different subgroups. The Kaplan-Meier method was used to plot the cumulative recurrence rate curve for the time to organ failure resolution and Log-Rank test was used for comparison between two groups.Results:Overall, 212 patients with HTG-AP were enrolled, with 118 in the target-reaching group and 94 in the non-target-reaching group. There was no significantly statistical difference on baseline TG level between two groups, but patients in non-target-reaching group had higher total cholesterol, LDL and CRP than those in target-reaching group. The median OFFD with 14 days of admission in target-reaching and non-target-reaching group was 14.0(11.0, 14.0) and 14.0(13.0, 14.0) days, respectively, without significant difference ( P=0.279). Moreover, there was no significant difference on the presence of organ failure on day 7 and day 14, POF to day 14, new-onset organ failure to day 14, maximum SOFA score to day 14, incidence of IPN by day 60 of admission, length of ICU and hospital stay, mortality by day 60 of admission between two groups. Results of multivariate analysis revealed that there was no significant difference on OFFD between two groups. Subgroup analyses were performed according to age, body mass index, baseline acute physiology and chronic health evaluation-Ⅱ (APACHE-Ⅱ) score, and whether there was organ failure at baseline. However, no association of early reduction of TG with OFFD to day 14 was shown in any subgroup. Among the 67 patients with organ failure at baseline, there was no significant difference in the time to organ failure resolution between target-reaching group and non-target-reaching group ( HR=1.256, 95% CI 0.746-2.116; P=0.343). Conclusions:For patients with acute pancreatitis complicated with extremely severe HTG (TG≥22.6 mmol/L), rapid TG decline (TG≤5.65 mmol/L on day 3 after admission) is not associated with reduced incidence and shorter duration of organ failure.
