Dataset Information

High Triglyceride Variability Increases the Risk of First Attack of Acute Pancreatitis.

ABSTRACT:

Introduction

Hypertriglyceridemia is the third most common etiology of acute pancreatitis. Whether triglyceride variability, independent of absolute triglyceride levels, is a predictor of acute pancreatitis is unknown.

Methods

We identified 98,819 patients who were diagnosed with hyperlipidemia between January 1, 2007, and December 31, 2013, and had at least 1 triglyceride measurement annually for 4 consecutive years from the Chang Gung Research Database in Taiwan. Triglyceride variability, defined as variability independent of the mean, was calculated in the 4-year run-in period. The patients were stratified according to the quartiles of triglyceride variability and were followed until December 31, 2019, for first attack of acute pancreatitis.

Results

During a mean follow-up of 5.9 years, 825 (0.83%) patients were newly diagnosed with acute pancreatitis (14.1 events per 10,000 person-years; 95% confidence interval 13.2-15.1). Triglyceride variability was significantly associated with an increased risk of acute pancreatitis, independent of baseline triglyceride and mean triglyceride levels (hazard ratio, 1.28 [95% confidence interval 1.05-1.57] for the highest vs the lowest quartiles of triglyceride variability; P for trend = 0.006 over the quartiles of triglyceride variability). Subgroup analysis showed that this association was more pronounced among the patients with a higher neutrophil-to-lymphocyte ratio ( P for trend = 0.022).

Discussion

In this multi-institutional cohort study, high triglyceride variability was associated with an increased risk of first attack of acute pancreatitis, independent of baseline and mean triglyceride levels. The association between triglyceride variability and acute pancreatitis may be partly mediated by subclinical inflammation.

SUBMITTER: Tung YC

PROVIDER: S-EPMC10226468 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Publications

High Triglyceride Variability Increases the Risk of First Attack of Acute Pancreatitis.

Tung Ying-Chang YC Hsiao Fu-Chih FC Lin Chia-Pin CP Ho Chien-Te CT Hsu Tzyy-Jer TJ Chiang Hou-Yu HY Chu Pao-Hsien PH

The American journal of gastroenterology 20230130 6

<h4>Introduction</h4>Hypertriglyceridemia is the third most common etiology of acute pancreatitis. Whether triglyceride variability, independent of absolute triglyceride levels, is a predictor of acute pancreatitis is unknown.<h4>Methods</h4>We identified 98,819 patients who were diagnosed with hyperlipidemia between January 1, 2007, and December 31, 2013, and had at least 1 triglyceride measurement annually for 4 consecutive years from the Chang Gung Research Database in Taiwan. Triglyceride va ...[more]

PMID: 36716230

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Project description:Background and objectiveAcute pancreatitis (AP) is a complex inflammatory disorder with potential systemic repercussions including sepsis, multiple organ failure and mortality. As such, the development of a prognostic tool to assess the complications and severity of AP is critical as urgent medical intervention is warranted in cases of severe AP to prevent complications and reduce mortality. Despite the plethora of scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) score available for prognostication of AP, they often require manual invasive blood testing and lack the ability to monitor the dynamic progression of the disease. To this end, heart rate variability (HRV), a measure of the autonomic nervous system's modulation on cardiac activity, has emerged as a promising tool. Having been previously posited as a tool to monitor the progression of cardiovascular and neurological conditions, the use of HRV as a risk stratification tool for AP is highly plausible. Therefore, this study aims to synthesize the existing literature regarding the usage of HRV as a tool for the prognostication and monitoring of AP.MethodsA comprehensive literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus and Embase from inception to December 2023. Articles with mentions of AP and HRV were reviewed, and the complications of AP and its effects on HRV parameters were analyzed.Key content and findingsEarly studies on the use of HRV in AP have revealed the association of decreased HRV parameters with the development of subsequent complications, reflecting the suppression of sympathetic activity as a predominant driving force. In addition, HRV has also been shown to outperform other established scoring systems in predicting outcomes of the complications of AP, but more studies are needed to validate its accuracy.ConclusionsPreliminary studies have shown that certain parameters of HRV may be used to predict the severity of AP and prognosticate outcomes. Although HRV monitoring demonstrates potential to be superior to existing scoring systems in AP, more research is needed to validate its use as a prognostic tool. Nevertheless, the prospective utility of HRV monitoring in predicting the onset and outcomes of AP and its complications remains optimistic.

Project description:Background and objectivesAcute pancreatitis (AP) carries the risk of subsequent nutritional deficiencies. The prevalence of these deficiencies following a single episode of AP in children is unknown. We aimed to determine prevalence of anthropometric and laboratory-based measures of nutritional status in children following their first (index) admission for AP.MethodsProspective observational cohort study of patients ≤21 years of age with first episode of confirmed AP. Anthropometric and laboratory values were obtained at time of AP onset and at follow up time points of 3 and 12 months (m) post AP. AP attack was classified as either: mild, moderately severe or severe (which were combined in one group (SAP)).Results181 patients met criteria and were followed prospectively with 52% male, a median age of 13.7 years (IQR 9.4-16.0) and median Body Mass Index (BMI) Z-score of 0.6 (IQR -0.5, 1.6). Most patients had mild AP (140, 77%), with 23% meeting criteria for moderate or severe (41/181). 6 (3%) had diabetes mellitus (DM) predating AP and were excluded from further analysis. BMI Z-score remained stable during the follow up period. 13% of patients developed pre-DM or DM at 3m or 12m. Nearly one third of patients had low ferritin at 3m (29%) or 12m (29%). At 12m, 8% of patients had Vitamin A deficiency. 6% of patients had low Vitamin E levels at 3m and 5% at 12m. Over half of patients at both 3m and 12m had 25 OH Vitamin D insufficiency or deficiency (56% and 56%). Prolonged International Normalized Ratio (INR) (>1.3) was seen in 9% of patients at 12m. Very low albumin (<3.5 g/dL) was found in 24% of patients at 3m and 18% at 12m (Table 1). Patients with very low albumin at 3m were younger (median 10.7 vs. 14.2 years, p = 0.04), however sex, BMI Z-score and AP severity were not associated with albumin level. Although BMI Z-score did not differ between the groups, those with SAP had a significant decrease in BMI Z-score from first attack compared to mild AP at 3m (-0.4 vs. 0.0, p = 0.0002, Figure 2). At 3m, Vitamin E deficiency in SAP versus mild AP was found in 20% vs 2% (p = 0.04) and SAP had a lower median hematocrit (35.8 vs. 37.6, p = 0.046). There were no other laboratory significant differences at 3m in mild versus SAP groups. At 12m, those with SAP were more likely to have pre-DM or DM compared to mild AP (31% vs. 7%, p = 0.002). No other significant laboratory differences occurred at 12m.ConclusionsAfter the first AP attack patients experience nutritional deficiencies, including ferritin, all fat-soluble vitamins, and low albumin. SAP is associated with a decrease in BMI Z-score, increased prevalence of vitamin E deficiency at 3m, and an increase in pre-diabetes and diabetes at 12m. Serial monitoring of vitamin and mineral values post AP is warranted and further prospective studies are needed.

Dataset Information

High Triglyceride Variability Increases the Risk of First Attack of Acute Pancreatitis.

Introduction

Methods

Results

Discussion

Publications

High Triglyceride Variability Increases the Risk of First Attack of Acute Pancreatitis.

Similar Datasets

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