Incidence and Management of Hypertriglyceridemia-Associated Acute Pancreatitis: A Prospective Case Series in a Single Australian Tertiary Centre.

Autor: Tan HLE; Department of Diabetes & Endocrinology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia.; School of Medicine & Public Health, University of Newcastle, New Lambton Heights, NSW 2305, Australia., McDonald G; School of Medicine & Public Health, University of Newcastle, New Lambton Heights, NSW 2305, Australia.; Department of Medicine, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia., Payne A; Department of Medicine, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia., Yu W; Department of Medicine, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia., Ismadi Z; Department of Clinical Chemistry, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia., Tran H; School of Medicine & Public Health, University of Newcastle, New Lambton Heights, NSW 2305, Australia.; Department of Clinical Chemistry, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia., Gani J; School of Medicine & Public Health, University of Newcastle, New Lambton Heights, NSW 2305, Australia.; Department of Surgery, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia., Wynne K; Department of Diabetes & Endocrinology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia.; School of Medicine & Public Health, University of Newcastle, New Lambton Heights, NSW 2305, Australia.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2020 Dec 06; Vol. 9 (12). Date of Electronic Publication: 2020 Dec 06.
DOI: 10.3390/jcm9123954
Abstrakt: Background: Hypertriglyceridemia-associated acute pancreatitis (HTGAP) has been linked with increased severity and morbidity. In this study, triglyceride levels were measured in all patients admitted with acute pancreatitis (AP) to establish the incidence of HTGAP in an Australian center.
Methods: A prospective cohort with AP was collated over an 18-month period in a single tertiary referral hospital. HTGAP was defined as AP with triglycerides ≥ 11.2 mmol/L (1000 mg/dL). Incidence, clinical co-morbidities, severity and management strategies were recorded.
Results: Of the 292 episodes of AP, 248 (85%) had triglycerides measured and were included. HTGAP was diagnosed in 10 of 248 (4%) AP cases. Type 2 diabetes, obesity, alcohol misuse and gallstones were common cofactors. The HTGAP group demonstrated severe hypertriglyceridemia compared to the non-HTGAP group (median 51 mmol/L vs. 1.3 mmol/L). Intensive care unit (ICU) admissions were significantly increased (odds ratio (OR) 16; 95% CI 4-62) in the HTGAP group (5/10 vs. 14/238 admissions, p < 0.001) and constituted 26% (5/19) of total ICU admissions for AP. Four patients received intravenous insulin with fasting and had a rapid reduction in triglyceride levels by 65-77% within 24 h; one patient had mild hypoglycemia secondary to therapy.
Conclusion: HTGAP occurred in 4% of AP cases and was associated with higher risk of ICU admission. Intravenous insulin and fasting appear safe and efficacious for acutely lowering triglyceride levels in HTGAP.
Databáze: MEDLINE
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