| Aim:To investigate the recurrence rate of hypertriglyceridemia-induced acute pancreatitis(HTG-AP),explore risk factors for recurrence and construct risk prediction model of recurrence then evaluated the predictive performance of this model and early identification of high-risk populations for recurrence of HTG-AP through the model.Methods:This study prospectively included patients who were hospitalized in the Department of Gastroenterology,the First Affiliated Hospital of Nanchang University,from October 2019 to February 2021.These patients were followed up to recurrence or until February 2022.We collected the clinical data during hospitalization and during the follow-up period.Patients were divided into recurrent group and non-recurrent group.Baseline characteristics,clinical outcomes,blood lipid levels during hospitalization,and blood lipid levels during follow-up were compared between the two groups.Multivariate logistic regression analysis and a nomogram were conducted to explore independent risk factors for recurrence,and the Receiver Operating Characteristic(ROC)curve,calibration curve and decision curve were used for evaluation.Results:A total of 291 patients with HTG-AP were included,with a median follow-up of16.7 months.Recurrence occurred in 51 patients(17.5%).The recurrent group was younger(34.0(31.0,41.0)vs 40.0(32.0,47.0);P=0.013)and had a higher prevalence of fatty liver(90.2% vs 65.5%;P<0.001)than the non-recurrent group.Compared with the non-recurrent group,the recurrent group had higher triglyceride(TG)levels before discharge(4.0(2.9,6.4)vs 3.4(2.6,4.5);P=0.009),higher incidence of respiratory failure(27.5% vs 44.6%;P=0.024)and necrotizing pancreatitis(21.6% vs 36.3%;P=0.044),a lower rate of 72 h TG decline at admission(38.1(25.0,57.1)vs 50.6(31.2,67.9);P=0.026)and a shorter total hospital stay(7.0(5.0,11.0)vs 9.0(6.0,15.0);P=0.002),and hospitalization costs were lower(13.1(8.6,22.5)vs 22.5(13.4,46.9);P<0.001)during hospitalization.During follow-up,the TG level(4.4(2.9,8.7)vs 2.9(2.0,4.4);P < 0.001),glucose(Glu)level(7.1(5.7,10.6)vs5.8(5.1,7.1);P=0.004)and the proportion of lipid-lowering drug use <3 months(88.2%vs 65%;P=0.001)of the recurrence group was higher than those in the non-recurrent group.Multivariate logistic regression analysis showed that fatty liver disease(OR:4.039,95%CI:1.238-13.181;P=0.021),Short-term use of lipid-lowering drugs in convalescence(odds ratio(OR):0.160,95% confidence limit(CI):0.049-0.519;P=0.002),the TG level in convalescence(P<0.05)were independent risk factors for the recurrence of HTG-AP.Moderate elevation(5.65-11.3mmol/L)in TG was associated with a substantially increased risk with an adjusted odds ratio of 3.404(95%CI:1.239,9.355).Severe elevated levels of TG(>11.3mmol/L)were associated with a corresponding increase in risk of RAP,adjusted odds ratio 9.725(2.267,41.711).Incorporating these factors,the nomogram demonstrated good discrimination,calibration and clinical effectiveness,The area under the ROC curve was 0.807.Conclusions:(1)The recurrence rate of HTG-AP was 17.5%.Compared with the non-recurrent group,the patients in the recurrent group were younger,had a higher prevalence of fatty liver disease,higher TG levels and less lipid-lowering drugs during follow-up.(2)Fatty liver disease,the use of lipid-lowering drug and TG level during followup were closely related to the recurrence of HTG-AP.(3)The nomogram model constructed in this study has good prediction performance and has certain guiding significance. |
