Risk Factors For The Recurrence Of Hypertriglyceridemia-induced Acute Pancreatitis

Objectives:The purpose of this research was to to investigate the risk factors for recurrence of hypertriglyceridemia-induced acute pancreatitis(HTG-AP)by analyzing the clinical data of patients with HTG-AP in Qilu Hospital of Shandong University.Methods:This retrospective study enrolled 100 HTG-AP patients from January 1,2016 to January 1,2019 in Qilu Hospital.The clinical features and outcomes were analyzed in terms of general information,comorbidities,laboratory examination results,disease severity,length of stay,etc.Subjects who met the inclusion criteria were followed up for at least 12 months.According to the recurrence situation and whether the hospitalization data was from the first attack,these patients were divided into non-recurrent group,recurrent group one and recurrent group two.The risk factors for relapse of HTG-AP were preliminarily screened by univariate analysis.Then the cut-off value of continuous variables was determined by receiver operating characteristic curve(ROC).Finally,the independent risk factors affecting HTG-AP recurrence were identified by binary logistic regression analysis.Results:A total of 100 patients with HTG-AP were admitted in this study,and the minimum follow-up time was 12 months,46 patients with recurrence were included,containing 30 patients who relapsed during the follow-up period(recurrent group one),and 17 patients with previous history of HTG-AP before this study(recurrent group two).The whole relapse group was mostly male(78.7%)and young in age(the median age is 35).In this population,the prevalence of overweight and obesity(93.7%),fatty liver(89.4%),hyperlipidemia(97.9%),diabetes(44.7%)was high,while the prevalence of cerebral infarction and coronary heart disease was low.The majority of cases were mild(74.5%)with a median length of stay of 10 days.The comparison between non-recurrent group and recurrent group showed statistical differences in history of hyperlipidemia(P<0.001),gout(P=0.024),days between admission and the last lipid examination before discharge(P=0.012),admission TBIL level(P=0.031)and TG1/HDL-cl(reexamined TG/HDL-c level before hospital discharge)(P=0.005).Comparison between the three groups displayed differences in the history of hyperlipidemia(P<0.001),gout prevalence(P=0.008),reexamination interval days(P=0.033),TG1/HDL-cl value(P=0.020)and admission ALB level(P=0.011).Further pairwise comparison showed that there were differences in the history of hyperlipidemia(P<0.001)and TG1/HDL-cl value(P=0.017)between non-recurrent group and recurrent group one,while there were statistically differences in the history of hyperlipidemia(P<0.001),gout prevalence(P=0.011),admission ALB level(P=0.010)and TG1/HDL-c1 value(P=0.035)between non-recurrent group and recurrent group two.The cut-off value of TG1/HDL-c1 was 5.39.Binary logistic regression analysis revealed that the history of hyperlipidemia(P<0.001,OR=126.87 95%C1:14.09-1142.25)and TG1/HDL-c1≥5.39(P=0.028,OR=5.2395%CI:1.20-22.83)were independent risk factors for HTG-AP recurrence.Conclusion:The majority of HTG-AP patients were young and middle-aged males,and the disease was mild.The prevalence of overweight,obesity and diabetes was high.However,the recurrence was not related to age,gender,severity of disease and length of stay.History of hyperlipidemia and TG/HDL-C≥5.39 reviewed before discharge were independent risk factors for recurrence of HTG-AP.Among chronic complications,gout may be a risk factor for the recurrence of HTG-AP while recurrent HTG-AP may also be a risk factor for the occurrence of gout.After the first attack of HTG-AP,it is helpful to normalize TG level reach the standard as soon as possible and maintain the long-term stability of TG level to prevent recurrence.Prospective studies with larger samples and longer follow-up periods are needed to obtain more reliable results in the future.