Hypertriglyceridaemia as a risk factor for critical care admission in acute pancreatitis: A prospective study

Adiamah, Alfred; Kushairi, Anisa; Tumulty, Sue; Na, Yuuki; Crook, Martin; Brooks, Adam J.; Lobo, Dileep N.; Nottingham University Hospitals Hepatopancreaticobiliary Team

Abstract

Background and aims
Hypertriglyceridaemia is both a primary cause of acute pancreatitis and an epiphenomenon. This study aimed to define the associations between hypertriglyceridaemia and clinical outcomes in patients admitted with acute pancreatitis.

Methods
This single-centre prospective observational study included patients with a confirmed clinical, biochemical or radiological diagnosis of acute pancreatitis from August 2017 to September 2018. Baseline demographics, aetiology of pancreatitis, and fasting triglyceride concentrations were recorded and assessed against the surrogate markers of severity: admission to critical care, length of stay (LOS), readmission to hospital, and mortality.

Results
In total, 304 patients with a mean ± SD age of 56.1 ± 19.7 years met the inclusion criteria. There were 217 (71.4%) patients with normotriglyceridaemia ([less than] 150 mg/dL or [less than] 1.7 mmol/L), 47 (15.5%) with mild hypertriglyceridaemia (150–199 mg/dL or 1.7–2.25 mmol/L) and 40 (13.2%) with moderate-to-severe hypertriglyceridaemia (≥200 mg/dL or >2.25 mmol/L). The underlying aetiologies of acute pancreatitis were gallstones (55%), alcohol (18%), idiopathic (15%), hypertriglyceridaemia (9%), iatrogenic (2%) and bile duct abnormalities (1%). Patients with hypertriglyceridaemia were younger than those with normotriglyceridaemia (p [less than] 0.05). On multivariate regression, moderate-to-severe hypertriglyceridaemia (OR 5.66, 95% CI: 1.87 to 17.19, p = 0.002) and an elevated C-reactive protein concentration ≥120 mg/L (OR 1.00, 95% CI: 1.00–1.01, p = 0.040) were associated with admission to critical care. Moderate-to-severe hypertriglyceridaemia was also associated with an increased LOS (p = 0.002) but not readmission (p = 0.752) or mortality (p = 0.069).

Conclusion
Moderate-to-severe hypertriglyceridaemia in all aetiological causes of acute pancreatitis was predictive of admission to critical care and prolonged LOS but not readmission or mortality.

Citation

Adiamah, A., Kushairi, A., Tumulty, S., Na, Y., Crook, M., Brooks, A. J., …Nottingham University Hospitals Hepatopancreaticobiliary Team. (2020). Hypertriglyceridaemia as a risk factor for critical care admission in acute pancreatitis: A prospective study. Clinical Nutrition ESPEN, 39, 227-233. https://doi.org/10.1016/j.clnesp.2020.06.008

• Journal Article Type: Article
• Acceptance Date: Jun 12, 2020
• Online Publication Date: Jun 24, 2020
• Publication Date: 2020-10
• Deposit Date: Jun 17, 2020
• Publicly Available Date: Jun 25, 2021
• Journal: Clinical Nutrition ESPEN
• Print ISSN: 2405-4577
• Electronic ISSN: 2405-4577
• Peer Reviewed: Peer Reviewed
• Volume: 39
• Pages: 227-233
• DOI: https://doi.org/10.1016/j.clnesp.2020.06.008
• Public URL: https://nottingham-repository.worktribe.com/output/4667325
• Publisher URL: https://clinicalnutritionespen.com/article/S2405-4577(20)30123-6/fulltext