Retrospective Study On The Impact Of The Serum Triglyceride Level On The Prognosis Of Patients With Acute Pancreatitis

Objectives:Acute pancreatitis（AP）is an acute inflammatory disease that caused by abnormal activation of pancreatic enzymes for various etiologies,which can cause local inflammation response or systemic inflammation response,and even multiple organ failure.The incidence of acute pancreatitis is increasing,of which cholelithiasis,alcohol and hypertriglyceridemia is the main cause of AP,and the incidence of hypertriglyceridemia induced AP（HTG-AP）is significantly higher than before.HTGAP patients appear to have a severe disease course and a worse prognosis than those with patients caused by other etiologies.However,the impact of serum triglyceride（TG）level on the severity and prognosis of AP is controversial.This article mainly clarifies the following issue:By comparing the general conditions,laboratory indicators,clinical characteristics,etc.of patients with acute pancreatitis with different triglyceride（TG）levels,to explore whether the serum TG level at the early stage of onset will affect the severity and prognosis of AP,and to provide basis for early assessment and treatment of HTG-APMethods:1.To explore the similarities and differences in clinical characteristic of AP patients with different serum TG levels at the early stage of onset:Retrospectively collected the clinical data of patients with acute pancreatitis in the Department of Gastroenterology,General Surgery and Intensive Care Unit of Zhongda Hospital affiliated to Southeast University from January 2016 to December 2019 at Nanjing.The diagnostic criteria were based on the revision of Altanta in 2012.Age,sex,body mass index（BMI）,combined diseases,severity grade,blood fat,blood routine,hypersensitive c-reactive protein（hs-CRP）,amylase,liver function,APACHEII scores,case fatality,intensive care unit（ICU）occupancy,the incidence of systemic and local complications were collected.According to the serum TG value within 24 hours of admission,the patients were divided into normal TG group（TG<1.7mmol/L）and elevated TG group（TG≥1.7mmol/L）.And the elevated TG group was further divided into mild to moderate TG group（1.7mmol/L≤TG<11.2mmol/L）and the severe/very severe elevated TG group（TG≥11.2mmol/L）according to the degree of TG elevation,and the differences in clinical parameters and prognosis among the groups were compared.2.Statistical analysis:After collecting the above data,SPSS 19.0 was used for analysis.Measurement data of normal distribution are described by（mean±standard deviation）,and analyzed by t-test or one-way analysis of variance;the measurement data of non-normal distribution are described by median and quartile,and analyzed by rank sum test.The counting data are described by absolute counts and percentages,and analyzed by chi-square test;for the measurement data of normal distribution,variance analysis trend test was used to analyze their correlation;for the measurement data of non-normal distribution,Kruskal-Wallis H test was used to analyze their correlation;the linear trend test analyze the association between counting data.P<0.05 means statistical significance.Results:1.A total of 276 patients with acute pancreatitis were enrolled,including 127 patients in the normal TG group and 149 patients in the elevated TG group.The elevated TG group were further divided into subgroups according to the degree of TG elevation,78 patients in the mild to moderate elevated TG group and 71 patients in the severe/very severe elevated TG group.2.In the comparison of clinical data between the normal TG group and the elevated TG group,compared with the normal TG group,the patients in the elevated TG group were younger（41.29±12.30 vs.64.79±17.90,P<0.01）,the proportion of patients with BMI≥28kg/m2 was higher（39.6%vs.5.5%,P<0.01）,and they were more likely to have type 2 diabetes（39.6%vs.17.3%,P<0.01）and fatty liver（81.2%vs.21.3%,P<0.01）.The levels of white blood cell count（WBC）,neutrophil/lymphocyte ratio（NLR）,hematocrit（HCT）,hs-CRP,and APACHEII score in the elevated TG group were all higher than those in the normal TG group（P value all<0.05）.Compared with the normal TG group,ICU occupancy rate（18.1%vs 9.4%,P<0.05）and the incidence of systemic inflammatory response syndrome（SIRS）（70.5%vs 50.4%,P<0.01）of the TG elevated group were higher.Patients in the elevated TG group were more likely to have acute peripancreatic fluid collection（APFC）（33.6%vs 22.0%,P<0.05）.However,there were no statistic difference in case fatality,the incidence of multiple organ dysfunction syndrome（MODS）,the incidence of respiratory failure,the incidence of shock,the incidence of renal failure,the incidence of acute necrotic collection（ANC）and infected pancreatic necrosis（IPN）between two groups（P value all>0.05）.3.In the comparison of clinical data of patients with different TG levels,compared with the normal TG group,patients with more severe TG elevation were younger(normal TG group was 64.79±17.09 years old,mild to moderate elevated TG group was 44.36±13.86 years old,severe/very severe elevated TG group was 37.92 ±9.32 years old,P_trend<0.01),the proportion of males was larger(56.7%in normal group,62.8%in mild to moderate elevated TG group,and 73.2%in severe/very severe elevated TG group,P_trend<0.05),the proportion of BMI≥28kg/m2 was larger(5.5%in normal TG group,33.3%in mild to moderate elevated TG group,46.5%in sever/very severe elevated TG group,P_trend<0.01),and they were more likely to have type 2 diabetes(17.3%in the normal TG group,21.8%in the mildly to moderate elevated TG group,59.2%in the severe/very severe elevated TG group,P_trend<0.01)and fatty liver(21.3%in the normal TG group,74.4%in the mild to moderate TG elevated group,88.7%in the severe/very severe elevated TG group,P_trend<0.01).The ICU occupancy rate was higher in the severe/very severe elevated TG group,accounting for 18/71 patients(25.4%,P_trend<0.05).Respiratory failure developed in 20/127（15.7%）in the normal TG group,14/78（17.9%）in the mild to moderate elevated TG group,21/71（29.6%）in the severe/very severe elevated TG group(P_trend<0.05);SIRS developed in 64/127（50.4%）in the normal TG group,42/78（53.8%）in the mild to moderate elevated TG group,63/71（88.7%）in the severe/very severe elevated TG group,(P_trend<0.05).Patients in the severe/very severe elevated TG group were more likely to have APFC（38.0%）,ANC（21.1%）and IPN（7.0%）than those in the normal TG group and the mild to moderate elevated TG group(P_trend<0.05).4.In multivariate analysis,after controlling for age,type 2 diabetes,fatty liver and BMI,the serum TG level in the early stage of onset was an independent risk factor for SIRS（OR=1.084,95%CI:1.031-1.140,P=0.002）in AP patients.Conclusion:1.The APACHEII score,ICU occupancy rate,the incidence of SIRS and the incidence of APFC of the elevated TG group are significantly higher than those in the normal TG group.In the stratification analysis,with the degree of TG increases,ICU occupancy rate,the incidence of respiratory failure,the incidence of SIRS,the incidence of APFC,ANC and IPN in AP patients increased,suggesting that as the degree of TG increases,the prognosis of AP patients is worse.2.Multivariate analysis shows that serum TG level in the early stage of onset is an independent risk factor for SIRS in AP patients.3.For patients with severely elevated TG levels,relevant treatment measures should be taken as soon as possible,which may reduce the risk of SIRS in AP patients and may improve the prognosis of AP patients.