Correlation Study Of Serum Triglyceride Level And Severity Of Acute Biliary Pancreatitis

Background Acute pancreatitis(AP)is a clinically common emergency abdomen induced by cholelithiasis,hypertriglyceridemia(HTG),alcohol abuse,and other factors.Acute biliary pancreatitis is the most common type of AP in China and abroad,with an acute onset and rapid progression,and some patients can progress to severe AP(SAP).Previous studies have shown that HTG can induce HTG-AP and aggravate its condition,and some ABP patients also have HTG before onset and develop elevated serum triglyceride(TG)levels in the early stage,but the effect of serum TG levels on ABP is still unclear.Objective In this study,we investigated the correlation between serum TG levels and the severity of ABP by comparing and analyzing the clinical data of patients with different TG levels of ABP and analyzing the general data and outcome indicators of patients with different TG levels of ABP using a trend test.Methods 1.The clinical data of 526 ABP patients admitted to Northern Jiangsu People’s Hospital from January 2016 to December 2020 were retrospectively evaluated in accordance with the inclusion and exclusion criteria established in this study.2.According to the serum TG values measured within 24 hours of admission,ABP patients were divided into normal TG group(TG<1.7mmol/L)and elevated TG group(TG≥1.7mmol/L).On the basis of the degree of elevated serum TG levels,the elevated TG group was further categorized into three subgroups,the mildly elevated TG group(1.7mmol/L≤TG<2.26mmol/L),the moderately elevated TG group(2.26mmol/L≤TG<5.65 mmol/L),and the severely elevated TG group(TG≥5.65mmol/L).The general data,laboratory parameters,local complications,and severity of the disease were compared among the ABP patients in each group,respectively.3.To further confirm the relationship between serum TG levels and the severity of ABP,we compared the TG values and the proportion of ABP patients with severely elevated TG in the mild AP(MAP),mild moderately severe AP(MSAP)and SAP subgroups.4.Logistic regression analysis was applied to explore independent risk factors related to organ failure and local complications in ABP patients.5.Laboratory parameters included: TG,hematocrit(HCT),white blood cell(WBC),Creactive protein(CRP),high density lipoprotein-C(HDL-C),total bilirubin(TB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),blood urea nitrogen(BUN),blood creatinine(CRE),blood calcium(Ca2 +),blood glucose(GLU),blood amylase(AMY),and blood lipase(LIP).Results 1.A total of 526 ABP patients were included in this study.Of these,394 were in the normal TG group,and 132 were in the elevated TG group.In the TG elevation group,there were 36 patients in the mildly elevated TG group,57 patients in the moderately elevated TG group,and 39 patients in the severely elevated TG group.2.Comparison of clinical data of ABP patients in the normal TG group and the elevated TG group: in terms of general data,there were statistical differences between the two groups in regard to age,gender,body mass index(BMI),waist circumference(WC)and history of diabetes(P<0.05).Patients in the elevated TG group had a younger mean age,were predominantly male,and had a higher proportion of a history of diabetes.In addition,the mean levels of BMI and WC were significantly higher in the elevated TG group than in the normal TG group.There was no significant statistical difference in other previous medical histories between the two groups.In terms of laboratory parameters,TG,HCT,WBC,CRP,CRE,and GLU in the elevated TG group were significantly higher compared with the normal TG group,while HDL-C,TB,ALT,AST,AMY,and LIP were significantly lower than in the normal TG group(P<0.05),and there was no statistically significant difference between the two groups regarding LDH,BUN,and Ca2 +(P>0.05).In terms of outcome indicators,the elevated TG group had a higher incidence of MSAP and SAP than in the normal TG group(P<0.05).The incidence of persistent organ failure and overall local complications was markedly higher in the elevated TG group than in the normal TG group.In particular,the incidence of persistent respiratory failure,persistent renal failure,acute peripancreatic fluid collection(APFC)and acute necrotic collection(ANC)was significantly higher than in the normal TG group(P<0.05).In addition,the incidence of systemic inflammatory response syndrome(SIRS)was also significantly higher in the elevated TG group compared with the normal TG group(P<0.05).However,there was no statistical difference in persistent heart failure,transient organ failure,and ICU admission rate between the two groups.3.Comparison of clinical data of ABP patients with different TG levels: in terms of general data,the younger the mean age of patients,the higher the proportion of males,the higher the BMI and WC,the higher the proportion of patients with a history of diabetes,and the higher the serum TG level(Ptrend <0.05).In terms of laboratory parameters,there were statistically significant differences in TG,HCT,WBC,CRP,HDL-C,ALT,AST,GLU,CRE,Ca2+,AMY,and LIP in the four groups(P<0.05),while there was no significant difference of TB,BUN,and CRE in the TG stratification(P>0.05).In terms of outcome indicators,the more severely elevated TG levels,the more likely patients were to develop MASP,SAP,persistent heart failure,persistent respiratory failure,persistent kidney failure,APFC,and ANC(Ptrend <0.05).In addition,the incidence of SIRS and the ICU transfer rate were also higher(Ptrend <0.05).4.Correlation between the severity of ABP and serum TG levels: TG values and the proportion of ABP patients with severely elevated TG gradually increased in MAP,MSAP,and SAP,with statistical differences between the two groups compared to each other(P<0.05).5.Logistic regression analysis of outcome indicators: gender,age ≥60 years,BMI,presence of history of alcohol consumption,history of smoking,history of hypertension,history of coronary heart disease,history of diabetes mellitus,history of ≥1 previous AP occurrence and different TG levels stratified as independent variables were included in the logistic regression model for univariate and multivariate analysis,showing that TG≥5.65mmol/L was an independent risk factor for the development of persistent respiratory failure(OR=12.332,95%CI 3.843–39.575),persistent renal failure(OR=10.019,95%CI 1.636–61.373),APFC(OR=2.501,95%CI 1.232–5.076)and ANC(OR=5.021,95%CI 1.727–14.594),and the OR for TG was higher than other independent risk factors.Conclusion 1.ABP patients with elevated TG levels were younger,predominantly male,and had a higher proportion of diabetes history.2.Elevated TG levels aggravate the inflammatory response in ABP patients,and the higher the TG level,the higher the risk of SIRS in ABP patients.3.The higher the serum TG level in the early stage of ABP patients,the more severe the disease,which is more likely to lead to the development of persistent respiratory failure,persistent renal failure,APFC,and ANC.4.TG≥5.65mmol/L is an independent risk factor for the development of persistent respiratory failure,persistent renal failure,APFC and ANC in ABP patients.