Triglyceride-lowering therapies in hypertriglyceridemia-associated acute pancreatitis in China: a multicentre prospective cohort study.

Autor: Zhou J; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.; National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.; Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical School University, Nanjing, China., Wang Z; Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, China., Liu Q; Department of Emergency, GanZhou People's Hospital, Nanchang University, Nanchang, China., Cao L; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.; National Institute of Healthcare Data Science, Nanjing University, Nanjing, China., de-Madaria E; Department of Gastroenterology, Dr. Balmis, General University Hospital-ISABIAL, Alicante, Spain., Capurso G; Pancreato-Biliary Endoscopy and Endosonography Division, Clinical Research Centre, Pancreas Translational, and, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University , Milan, Italy., Stoppe C; Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, 97080, Germany., Wu D; Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Huang W; Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China., Chen Y; Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.; Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang, China., Liu S; Department of Emergency Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China., Hong D; Department of Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China., Sun Y; The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China., Zeng Z; Department of Critical Care Medicine, Medical Centre of Anesthesiology and Pain, The First Affiliated Hospital of Nanchang University, Nanchang, China., Qin K; Department of Emergency Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China., Ni H; Department of Emergency Medicine, Jiangsu Provincial Hospital of Integrated Chinese and Western Medicine, Nanjing, China., Sun Y; The Fourth Department of the Digestive Disease Centre, Suining Central Hospital, Suining, China., Long Y; Department of Critical Care Medicine, Qian Xi Nan People's Hospital, Zunyi Medical University, Zunyi, China., Guo F; Department of Intensive Care Unit, Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou, China., Liu X; Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China., Zheng X; Department of Critical Care Medicine, Nanyang Central Hospital, Nanyang, China., Zhang G; Department of Emergency Medicine, The First Affiliated Hospital and College of Clinical Medicineof , Henan University of Science and Technology, Luoyang, China., Zhang X; Department of ICU, The Affiliated Huaian No. 1, People's Hospital of Nanjing Medical University, Huaian, China., Zhou K; Department of Emergency, Medical Centre Hospital of Qionglai City, Chengdu, China., Chen Y; Department of Critical Care Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China., Jiao Q; Department of Critical Care Medicine, The First Hospital of HanDan, Handan, China., Zou X; Department of Critical Care Medicine, Bishan Hospital of Chongqing Medical University, Chongqing, China., Luo X; Department of Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China., Li G; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China., Ye B; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China., Li C; Department of Epidemiology and Health Statistics, School of Public Health, Jiaotong University Health Science Centre, Xi'an, China., Wang L; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China., Li S; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China., Windsor J; Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand., Liu Y; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.; National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.; Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China., Tong Z; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China., Li W; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. ctgchina@medbit.cn.; National Institute of Healthcare Data Science, Nanjing University, Nanjing, China. ctgchina@medbit.cn.; Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical School University, Nanjing, China. ctgchina@medbit.cn., Ke L; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. ctgkelu@nju.edu.cn.; National Institute of Healthcare Data Science, Nanjing University, Nanjing, China. ctgkelu@nju.edu.cn.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2024 Nov 15; Vol. 22 (1), pp. 535. Date of Electronic Publication: 2024 Nov 15.
DOI: 10.1186/s12916-024-03755-8
Abstrakt: Background: No specific triglyceride-lowering therapy is recommended in patients with hypertriglyceridemia-associated acute pancreatitis (HTG-AP), primarily because of the lack of quality evidence. This study aimed to describe practice variations in triglyceride-lowering therapies for early HTG-AP patients and assess whether more rapid triglyceride decline is associated with improving organ failure.
Methods: This is a multicentre, prospective cohort study recruiting HTG-AP patients with elevated plasma triglyceride (> 11.3 mmol/L) admitted within 72 h from the onset of symptoms. Patients were dichotomised on study day 3 into either target reaching (plasma triglyceride ≤ 5.65 mmol/L) or not. The primary outcome was organ failure-free days (OFFD) to 14 days of enrolment. The association between target-reaching and OFFD was modelled. Additionally, the slope in plasma triglyceride over the first three days in response to treatment was calculated, and its association with OFFD was assessed as a sensitivity analysis.
Results: Among the 300 enrolled patients, 211 underwent exclusive medical treatment, and 89 underwent various blood purification therapies. Triglyceride levels were available in 230 patients on study day 3, among whom 122 (53.0%) had triglyceride levels of ≤ 5.65 mmol/l. The OFFD was not different between these patients and those in whom plasma triglyceride remained > 5.65 mmol/L [median (IQR): 13 (10-14) vs. 14 (10-14), p = 0.46], even after adjustment for potential confounders. For the decline slopes, there was no significant change in OFFD with a steeper decline slope [risk difference, - 0.088, 95% CI, - 0.334 to 0.158, p = 0.48].
Conclusions: Triglyceride-lowering therapies vary greatly across centres. More rapid triglyceride decline was not associated with improving incidence and duration of organ failure.
Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the ethics committee of Jinling Hospital (ethical number: 2020NZKY-016–01) and registered with the Chinese Clinical Trial Registry (ChiCTR2000039541). The local hospital ethics committees of all the participating sites also approved the trial. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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