Clinical features of severe acute hypertriglyceridemic pancreatitis

Objective To investigate the clinical features of severe acute hypertriglyceridemic pancreatitis ( HTGP) . Methods A retrospective analysis was performed for the clinical data of 179 patients with moderate severe pancreatitis ( MSAP) or severe acute pancreatitis ( SAP) who were admitted to The First Affiliated Hospital of Guangxi Medical University from January 2013 to June 2016. According to the etiology, these patients were divided into severe biliogenic acute pancreatitis ( biliogenic AP) group with 68 patients, severe alcoholic acute pancreatitis ( alcoholic AP) group with 39 patients, severe acute HTGP group with 45 patients, and severe acute pancreatitis group with other causes ( other group) with 27 patients. Related data of the patients with clear causes in the former three groups were recorded, including demographic data, blood triglyceride ( TG) level on the first day of admission, cause, pancreatic necrosis, systemic complications [acute respiratory distress syndrome ( ARDS) , acute renal injury, hypotension, and disseminated intravascular coagulation ( DIC) ], and related clinical outcomes ( admission to the intensive care unit, length of hospital stay, and mortality rate) . In order to investigate the influence of TG concentration on the prognosis of AP patients, the patients were divided into normal blood lipid group with 82 patients, mild dyslipidemia group with 52 patients, moderate dyslipidemia group with 28 patients, and severe dyslipidemia group with 17 patients, according to the TG level on the first day of admission, and the incidence rates of systemic complications, pancreatic necrosis, and clinical outcomes were analyzed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between groups, and the Spearman rank correlation test was used for correlation analysis. Results Biliary tract disease remained the leading cause of SAP ( 38%) , followed by hypertriglyceridemia ( 25%) . As for systemic complications, the HTGP group had a significantly higher incidence rate of ARDS than the biliogenic AP group and the alcoholic AP group ( P = 0. 014 and0. 022) . In the groups with different TG levels, the incidence rates of ARDS and acute renal injury were positively correlated with TG level ( r = 0. 966 and 0. 982, P = 0. 004 and 0. 019) . Conclusion The HTGP group has a higher incidence rate of ARDS than the biliogenic AP group and the alcoholic AP group, and the risk of ARDS and acute renal injury tends to increase with the increasing TG level.