Haq Nawaz1, Efstratios Koutroumpakis1, Jeffrey Easler1, Adam Slivka1, David C Whitcomb1, Vijay P Singh2, Dhiraj Yadav1, Georgios I Papachristou1,3. 1. Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 2. Department of Medicine, Division of Gastroenterology, Mayo Clinic, Scottsdale, Arizona, USA. 3. Division of Gastroenterology, Department of Medicine, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA.
Abstract
OBJECTIVES: Hypertriglyceridemia (HTG) represents a major health problem with prevalence exceeding 30% in the U.S. The present study aims to assess the effect of elevated serum triglyceride (TG) levels on the severity of acute pancreatitis (AP). METHODS: Prospectively enrolled AP patients were categorized into normal, mild, moderate, and severe/very severe categories based on their TG levels and compared in respect to demographics, comorbidities, and clinical outcomes. Multivariate analysis determined whether elevated TG levels were independently associated with persistent organ failure. RESULTS: Two hundred and one out of 400 AP patients had serum TGs measured within 72 h of presentation, of which 115 had normal TG levels and 86 HTG (20 mild, 41 moderate, and 25 severe/very severe). Patients with HTG were of younger age (44 vs. 52 years), predominantly male (65% vs. 45%), obese (57% vs. 34%), diabetic (38% vs. 17%), and developed more frequently persistent organ failure (40% vs. 17%) compared with those with normal TGs (P<0.02). The rate of persistent organ failure increased proportionally with HTG severity grades (17% when normal TGs, 30% in mild, 39% in moderate, and 48% in severe/very severe HTG, Ptrend<0.001). On multivariate analysis controlling for age, gender, body mass index, diabetes, and alcohol etiology, moderate HTG (odds ratio (OR), 2.6; P=0.04) and severe/very severe HTG (OR, 4.9; P=0.009) were independently associated with persistent organ failure. CONCLUSIONS: Elevated serum TGs in AP patients are independently and proportionally correlated with persistent organ failure regardless of etiology. TG-mediated lipotoxicity may be an attractive target to design novel interventions for severe AP.
OBJECTIVES:Hypertriglyceridemia (HTG) represents a major health problem with prevalence exceeding 30% in the U.S. The present study aims to assess the effect of elevated serum triglyceride (TG) levels on the severity of acute pancreatitis (AP). METHODS: Prospectively enrolled AP patients were categorized into normal, mild, moderate, and severe/very severe categories based on their TG levels and compared in respect to demographics, comorbidities, and clinical outcomes. Multivariate analysis determined whether elevated TG levels were independently associated with persistent organ failure. RESULTS: Two hundred and one out of 400 AP patients had serum TGs measured within 72 h of presentation, of which 115 had normal TG levels and 86 HTG (20 mild, 41 moderate, and 25 severe/very severe). Patients with HTG were of younger age (44 vs. 52 years), predominantly male (65% vs. 45%), obese (57% vs. 34%), diabetic (38% vs. 17%), and developed more frequently persistent organ failure (40% vs. 17%) compared with those with normal TGs (P<0.02). The rate of persistent organ failure increased proportionally with HTG severity grades (17% when normal TGs, 30% in mild, 39% in moderate, and 48% in severe/very severe HTG, Ptrend<0.001). On multivariate analysis controlling for age, gender, body mass index, diabetes, and alcohol etiology, moderate HTG (odds ratio (OR), 2.6; P=0.04) and severe/very severe HTG (OR, 4.9; P=0.009) were independently associated with persistent organ failure. CONCLUSIONS: Elevated serum TGs in AP patients are independently and proportionally correlated with persistent organ failure regardless of etiology. TG-mediated lipotoxicity may be an attractive target to design novel interventions for severe AP.
Authors: Sarah Navina; Chathur Acharya; James P DeLany; Lidiya S Orlichenko; Catherine J Baty; Sruti S Shiva; Chandra Durgampudi; Jenny M Karlsson; Kenneth Lee; Kyongtae T Bae; Alessandro Furlan; Jaideep Behari; Shiguang Liu; Teresa McHale; Larry Nichols; Georgios Ioannis Papachristou; Dhiraj Yadav; Vijay P Singh Journal: Sci Transl Med Date: 2011-11-02 Impact factor: 17.956
Authors: Lars Berglund; John D Brunzell; Anne C Goldberg; Ira J Goldberg; Frank Sacks; Mohammad Hassan Murad; Anton F H Stalenhoef Journal: J Clin Endocrinol Metab Date: 2012-09 Impact factor: 5.958
Authors: Emmanuel I González-Moreno; José A González-González; Elvira Garza-González; Francisco J Bosques-Padilla; Héctor J Maldonado-Garza Journal: Am J Gastroenterol Date: 2016-01 Impact factor: 10.864
Authors: Laura Y Sue; Michael Batech; Dhiraj Yadav; Stephen J Pandol; William A Blumentals; Lenore Soodak von Krusenstiern; Wansu Chen; Bechien U Wu Journal: Pancreas Date: 2017-08 Impact factor: 3.327