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Erschienen in: Digestive Diseases and Sciences 12/2021

19.01.2021 | Original Article

Necrotizing Pancreatitis from Hypertriglyceridemia: More Severe Disease?

verfasst von: T. K. Maatman, J. A. Westfall-Snyder, E. P. Ceppa, M. G. House, A. Nakeeb, T. K. Nguyen, C. M. Schmidt, N. J. Zyromski

Erschienen in: Digestive Diseases and Sciences | Ausgabe 12/2021

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Abstract

Background

Necrotizing pancreatitis (NP) is caused by hypertriglyceridemia (HTG) in up to 10% of patients. Clinical experience suggests that HTG-NP is associated with increased clinical severity; objective evidence is limited and has not been specifically studied in NP.

Aim

The aim of this study was to critically evaluate outcomes in HTG-NP. We hypothesized that patients with HTG-NP had significantly increased severity, morbidity, and mortality compared to patients with NP from other etiologies.

Methods

A case–control study of all NP patients treated at a single institution between 2005 and 2018 was performed. Diagnostic criteria of HTG-NP included a serum triglyceride level > 1000 mg/dL and the absence of another specific pancreatitis etiology. To control for differences in age, sex, and comorbidities, non-HTG and HTG patients were matched at a 4:1 ratio using propensity scores. Outcomes were compared between non-HTG and HTG patients.

Results

A total of 676 NP patients were treated during the study period. The incidence of HTG-NP was 5.8% (n = 39). The mean peak triglyceride level at diagnosis was 2923 mg/dL (SEM, 417 mg/dL). After propensity matching, no differences were found between non-HTG and HTG patients in CT severity index, degree of glandular necrosis, organ failure, infected necrosis, necrosis intervention, index admission LOS, readmission, total hospital LOS, or disease duration (P = NS). Mortality was similar in non-HTG-NP (7.1%) and HTG-NP (7.7%), P = 1.0.

Conclusion

In this large, single-institution series, necrotizing pancreatitis caused by hypertriglyceridemia had similar disease severity, morbidity, and mortality as necrotizing pancreatitis caused by other etiologies.
Literatur
1.
Zurück zum Zitat Peery AF, Crockett SD, Barritt AS, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149:1731–1741e3.CrossRef Peery AF, Crockett SD, Barritt AS, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149:1731–1741e3.CrossRef
2.
Zurück zum Zitat Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–2400.CrossRef Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–2400.CrossRef
3.
Zurück zum Zitat Freeman M, Werner J, van Santvoort H, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41:1176–1194.CrossRef Freeman M, Werner J, van Santvoort H, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41:1176–1194.CrossRef
4.
Zurück zum Zitat Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:e1–e15.CrossRef Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:e1–e15.CrossRef
5.
Zurück zum Zitat Maatman TK, Mahajan S, Roch AM, et al. High rates of readmission in necrotizing pancreatitis: natural history or opportunity for improvement? J Gastrointest Surg. 2019;23:1834–1839.CrossRef Maatman TK, Mahajan S, Roch AM, et al. High rates of readmission in necrotizing pancreatitis: natural history or opportunity for improvement? J Gastrointest Surg. 2019;23:1834–1839.CrossRef
6.
Zurück zum Zitat Roch AM, Maatman T, Carr RA, et al. Evolving treatment of necrotizing pancreatitis. Am J Surg. 2018;215:526–529.CrossRef Roch AM, Maatman T, Carr RA, et al. Evolving treatment of necrotizing pancreatitis. Am J Surg. 2018;215:526–529.CrossRef
7.
Zurück zum Zitat Carr RA, Rejowski BJ, Cote GA, et al. Systematic review of hypertriglyceridemia-induced acute pancreatitis: a more virulent etiology? Pancreatology. 2016;16:469–476.CrossRef Carr RA, Rejowski BJ, Cote GA, et al. Systematic review of hypertriglyceridemia-induced acute pancreatitis: a more virulent etiology? Pancreatology. 2016;16:469–476.CrossRef
8.
Zurück zum Zitat Valdivielso P, Ramirez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med. 2014;25:689–694.CrossRef Valdivielso P, Ramirez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med. 2014;25:689–694.CrossRef
9.
Zurück zum Zitat de Pretis N, Amodio A, Frulloni L. Hypertriglyceridemic pancreatitis: epidemiology, pathophysiology and clinical management. United European Gastroenterol J. 2018;6:649–655.CrossRef de Pretis N, Amodio A, Frulloni L. Hypertriglyceridemic pancreatitis: epidemiology, pathophysiology and clinical management. United European Gastroenterol J. 2018;6:649–655.CrossRef
10.
Zurück zum Zitat Pascual I, Sanahuja A, Garcia N, et al. Association of elevated serum triglyceride levels with a more severe course of acute pancreatitis: cohort analysis of 1457 patients. Pancreatology. 2019;19:623–629.CrossRef Pascual I, Sanahuja A, Garcia N, et al. Association of elevated serum triglyceride levels with a more severe course of acute pancreatitis: cohort analysis of 1457 patients. Pancreatology. 2019;19:623–629.CrossRef
11.
Zurück zum Zitat Mosztbacher D, Hanak L, Farkas N, et al. Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases. Pancreatology. 2020. Mosztbacher D, Hanak L, Farkas N, et al. Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases. Pancreatology. 2020.
12.
Zurück zum Zitat Yin G, Hu G, Cang X, et al. C-reactive protein: rethinking its role in evaluating the severity of hyperlipidemic acute pancreatitis. Pancreas. 2014;43:1323–1328.CrossRef Yin G, Hu G, Cang X, et al. C-reactive protein: rethinking its role in evaluating the severity of hyperlipidemic acute pancreatitis. Pancreas. 2014;43:1323–1328.CrossRef
13.
Zurück zum Zitat Qiu L, Sun RQ, Jia RR, et al. Comparison of existing clinical scoring systems in predicting severity and prognoses of hyperlipidemic acute pancreatitis in chinese patients: a retrospective study. Medicine. 2015;94:e957.CrossRef Qiu L, Sun RQ, Jia RR, et al. Comparison of existing clinical scoring systems in predicting severity and prognoses of hyperlipidemic acute pancreatitis in chinese patients: a retrospective study. Medicine. 2015;94:e957.CrossRef
14.
Zurück zum Zitat Huang YX, Jia L, Jiang SM, et al. Incidence and clinical features of hyperlipidemic acute pancreatitis from Guangdong, China: a retrospective multicenter study. Pancreas. 2014;43:548–552.CrossRef Huang YX, Jia L, Jiang SM, et al. Incidence and clinical features of hyperlipidemic acute pancreatitis from Guangdong, China: a retrospective multicenter study. Pancreas. 2014;43:548–552.CrossRef
15.
Zurück zum Zitat Kim SJ, Kang H, Kim EJ, et al. Clinical features and outcomes of hypertriglyceridemia-induced acute pancreatitis: Propensity score matching analysis from a prospective acute pancreatitis registry. Pancreatology. 2020. Kim SJ, Kang H, Kim EJ, et al. Clinical features and outcomes of hypertriglyceridemia-induced acute pancreatitis: Propensity score matching analysis from a prospective acute pancreatitis registry. Pancreatology. 2020.
16.
Zurück zum Zitat Balachandra S, Virlos IT, King NK, et al. Hyperlipidaemia and outcome in acute pancreatitis. Int J Clin Pract. 2006;60:156–159.CrossRef Balachandra S, Virlos IT, King NK, et al. Hyperlipidaemia and outcome in acute pancreatitis. Int J Clin Pract. 2006;60:156–159.CrossRef
17.
Zurück zum Zitat Pothoulakis I, Paragomi P, Archibugi L, et al. Clinical features of hypertriglyceridemia-induced acute pancreatitis in an international, multicenter, prospective cohort (APPRENTICE consortium). Pancreatology. 2020;20:325–330.CrossRef Pothoulakis I, Paragomi P, Archibugi L, et al. Clinical features of hypertriglyceridemia-induced acute pancreatitis in an international, multicenter, prospective cohort (APPRENTICE consortium). Pancreatology. 2020;20:325–330.CrossRef
18.
Zurück zum Zitat Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111.CrossRef Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111.CrossRef
19.
Zurück zum Zitat Balthazar E, Robinson D, Megibow A, et al. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174:331–336.CrossRef Balthazar E, Robinson D, Megibow A, et al. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174:331–336.CrossRef
20.
Zurück zum Zitat Maatman TK, Roch AM, Heimberger MA, et al. Disconnected pancreatic duct syndrome: spectrum of operative management. J Surg Res. 2020;247:297–303.CrossRef Maatman TK, Roch AM, Heimberger MA, et al. Disconnected pancreatic duct syndrome: spectrum of operative management. J Surg Res. 2020;247:297–303.CrossRef
21.
Zurück zum Zitat Maatman TK, Flick KF, Roch AM, et al. Operative pancreatic debridement: contemporary outcomes in changing times. Pancreatology 2020;[online ahead of print]. Maatman TK, Flick KF, Roch AM, et al. Operative pancreatic debridement: contemporary outcomes in changing times. Pancreatology 2020;[online ahead of print].
22.
Zurück zum Zitat Mayerle J, Sendler M, Hegyi E, et al. Genetics, cell biology, and pathophysiology of pancreatitis. Gastroenterology. 2019;156:1951–1968e1.CrossRef Mayerle J, Sendler M, Hegyi E, et al. Genetics, cell biology, and pathophysiology of pancreatitis. Gastroenterology. 2019;156:1951–1968e1.CrossRef
23.
Zurück zum Zitat Makhija R, Kingsnorth A. Cytokine storm in acute pancreatitis. J Hepatobiliary Pancreat Surg. 2002;9:401–410.CrossRef Makhija R, Kingsnorth A. Cytokine storm in acute pancreatitis. J Hepatobiliary Pancreat Surg. 2002;9:401–410.CrossRef
24.
Zurück zum Zitat Kylanpaa L, Rakonczay Z Jr, O’Reilly DA. The clinical course of acute pancreatitis and the inflammatory mediators that drive it. Int J Inflam. 2012;2012:360685.PubMedPubMedCentral Kylanpaa L, Rakonczay Z Jr, O’Reilly DA. The clinical course of acute pancreatitis and the inflammatory mediators that drive it. Int J Inflam. 2012;2012:360685.PubMedPubMedCentral
25.
Zurück zum Zitat Bhatia M, Wong FL, Cao Y, et al. Pathophysiology of acute pancreatitis. Pancreatology. 2005;5:132–144.CrossRef Bhatia M, Wong FL, Cao Y, et al. Pathophysiology of acute pancreatitis. Pancreatology. 2005;5:132–144.CrossRef
26.
Zurück zum Zitat Beger HG, Rau BM. Severe acute pancreatitis: clinical course and management. World J Gastroenterol. 2007;13:5043–5051.CrossRef Beger HG, Rau BM. Severe acute pancreatitis: clinical course and management. World J Gastroenterol. 2007;13:5043–5051.CrossRef
27.
Zurück zum Zitat Deng LH, Xue P, Xia Q, et al. Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis. World J Gastroenterol. 2008;14:4558–4561.CrossRef Deng LH, Xue P, Xia Q, et al. Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis. World J Gastroenterol. 2008;14:4558–4561.CrossRef
28.
Zurück zum Zitat Smeets X, Knoester I, Grooteman KV, et al. The association between obesity and outcomes in acute pancreatitis: an individual patient data meta-analysis. Eur J Gastroenterol Hepatol. 2019;31:316–322.CrossRef Smeets X, Knoester I, Grooteman KV, et al. The association between obesity and outcomes in acute pancreatitis: an individual patient data meta-analysis. Eur J Gastroenterol Hepatol. 2019;31:316–322.CrossRef
29.
Zurück zum Zitat Ding Y, Zhang M, Wang L, et al. Association of the hypertriglyceridemic waist phenotype and severity of acute pancreatitis. Lipids Health Dis. 2019;18:93.CrossRef Ding Y, Zhang M, Wang L, et al. Association of the hypertriglyceridemic waist phenotype and severity of acute pancreatitis. Lipids Health Dis. 2019;18:93.CrossRef
30.
Zurück zum Zitat Skipworth JR, Pereira SP. Acute pancreatitis. Curr Opin Crit Care. 2008;14:172–178.CrossRef Skipworth JR, Pereira SP. Acute pancreatitis. Curr Opin Crit Care. 2008;14:172–178.CrossRef
31.
Zurück zum Zitat Navina S, Acharya C, DeLany JP, et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med. 2011;3:107–110.CrossRef Navina S, Acharya C, DeLany JP, et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med. 2011;3:107–110.CrossRef
32.
Zurück zum Zitat De Waele B, Vanmierlo B, Van Nieuwenhove Y, et al. Impact of body overweight and class I, II and III obesity on the outcome of acute biliary pancreatitis. Pancreas. 2006;32:343–345.CrossRef De Waele B, Vanmierlo B, Van Nieuwenhove Y, et al. Impact of body overweight and class I, II and III obesity on the outcome of acute biliary pancreatitis. Pancreas. 2006;32:343–345.CrossRef
33.
Zurück zum Zitat Funnell IC, Bornman PC, Weakley SP, et al. Obesity: an important prognostic factor in acute pancreatitis. Br J Surg. 1993;80:484–486.CrossRef Funnell IC, Bornman PC, Weakley SP, et al. Obesity: an important prognostic factor in acute pancreatitis. Br J Surg. 1993;80:484–486.CrossRef
34.
Zurück zum Zitat Gloor B, Müller CA, Worni M, et al. Late mortality in patients with severe acute pancreatitis. Br J Surg. 2001;88:975–979.CrossRef Gloor B, Müller CA, Worni M, et al. Late mortality in patients with severe acute pancreatitis. Br J Surg. 2001;88:975–979.CrossRef
35.
Zurück zum Zitat Johnson CD, Toh SK, Campbell MJ. Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology. 2004;4:1–6.CrossRef Johnson CD, Toh SK, Campbell MJ. Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology. 2004;4:1–6.CrossRef
36.
Zurück zum Zitat Martínez J, Sánchez-Payá J, Palazón JM, et al. Obesity: a prognostic factor of severity in acute pancreatitis. Pancreas. 1999;19:15–20.CrossRef Martínez J, Sánchez-Payá J, Palazón JM, et al. Obesity: a prognostic factor of severity in acute pancreatitis. Pancreas. 1999;19:15–20.CrossRef
38.
Zurück zum Zitat Papachristou GI, Papachristou DJ, Avula H, et al. Obesity increases the severity of acute pancreatitis: performance of APACHE-O score and correlation with the inflammatory response. Pancreatology. 2006;6:279–285.CrossRef Papachristou GI, Papachristou DJ, Avula H, et al. Obesity increases the severity of acute pancreatitis: performance of APACHE-O score and correlation with the inflammatory response. Pancreatology. 2006;6:279–285.CrossRef
39.
Zurück zum Zitat Nawaz H, O’Connell M, Papachristou GI, et al. Severity and natural history of acute pancreatitis in diabetic patients. Pancreatology. 2015;15:247–252.CrossRef Nawaz H, O’Connell M, Papachristou GI, et al. Severity and natural history of acute pancreatitis in diabetic patients. Pancreatology. 2015;15:247–252.CrossRef
40.
Zurück zum Zitat Shen HN, Lu CL, Li CY. Effect of diabetes on severity and hospital mortality in patients with acute pancreatitis: a national population-based study. Diabetes Care. 2012;35:1061–1066.CrossRef Shen HN, Lu CL, Li CY. Effect of diabetes on severity and hospital mortality in patients with acute pancreatitis: a national population-based study. Diabetes Care. 2012;35:1061–1066.CrossRef
41.
Zurück zum Zitat Li X, Guo X, Ji H, et al. Relationships between metabolic comorbidities and occurrence, severity, and outcomes in patients with acute pancreatitis: a narrative review. Biomed Res Int. 2019;2019:2645926.PubMedPubMedCentral Li X, Guo X, Ji H, et al. Relationships between metabolic comorbidities and occurrence, severity, and outcomes in patients with acute pancreatitis: a narrative review. Biomed Res Int. 2019;2019:2645926.PubMedPubMedCentral
42.
Zurück zum Zitat Anderson F, Thomson SR, Clarke DL, et al. Dyslipidaemic pancreatitis clinical assessment and analysis of disease severity and outcomes. Pancreatology. 2009;9:252–257.CrossRef Anderson F, Thomson SR, Clarke DL, et al. Dyslipidaemic pancreatitis clinical assessment and analysis of disease severity and outcomes. Pancreatology. 2009;9:252–257.CrossRef
43.
Zurück zum Zitat Dominguez-Muñoz JE, Malfertheiner P, Ditschuneit HH, et al. Hyperlipidemia in acute pancreatitis. Relationship with etiology, onset, and severity of the disease. Int J Pancreatol. 1991;10:261–267.CrossRef Dominguez-Muñoz JE, Malfertheiner P, Ditschuneit HH, et al. Hyperlipidemia in acute pancreatitis. Relationship with etiology, onset, and severity of the disease. Int J Pancreatol. 1991;10:261–267.CrossRef
Metadaten
Titel
Necrotizing Pancreatitis from Hypertriglyceridemia: More Severe Disease?
verfasst von
T. K. Maatman
J. A. Westfall-Snyder
E. P. Ceppa
M. G. House
A. Nakeeb
T. K. Nguyen
C. M. Schmidt
N. J. Zyromski
Publikationsdatum
19.01.2021
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 12/2021
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-020-06766-6

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