Preliminary Study On The Value Of Non-alcoholic Fatty Liver And Hypertriglyceridemic Waist Phenotype In Assessment Of Patients With Acute Pancreatitis

Clinically,acute pancreatitis(AP)is one of the most common disease of acute abdomen.Most patients have self-limited condition and good prognosis.However,a small number of AP patients may have pancreatic hemorrhage and necrosis,secondary infection,peritonitis and shock.The mortality rate of them is very high.Therefore,early assessment and treatment are very important for the course of AP.At present,the number of patients with lipid metabolism disorders is increasing year by year,and many researchers have realized that it has an impact on the occurrence and prognosis of many diseases.Recent studies have shown that dyslipidemia plays an important role in the inflammation and prognosis of AP.For example,abdominal obesity is a specific manifestation of abnormal lipid metabolism,which is an independent risk factor for AP.Hypertriglyceridemic Waist Phenotype(HTGW)is a simple indicator of abdominal obesity.It was originally proposed by foreign scholars,and its relationship with acute pancreatitis has not been studied at present.The purpose of this study was to investigate the value of non-alcoholic fatty liver disease(NAFLD)and Hypertriglyceride waist circumference phenotype(HTGW)associated with abnormal lipid metabolism in assessing the severity of AP.The research is divided into two parts as follows.Part 1.Non-alcoholic fatty liver disease aggravated the severity of acute pancreatitis in patientsBackground:The incidence of non-alcoholic fatty liver disease(NAFLD)as a metabolic disease is increasing annually.In the present study,we aimed to explore the influence of NAFLD on the severity of acute pancreatitis(AP).Methods:The severity of AP was diagnosed and analyzed according to the 2012 revised Atlanta Classification.Outcome variables,including the severity of AP,organ failure(all types of organ failure,and systemic inflammatory response syndrome(SIRS),were compared for patients with and without NAFLD.Results:Six hundred and fifty-six patients were enrolled in the study and were divided into two groups according to the presence or absence of NAFLD.The non-NAFLD group contained 278 patients and the main etiology in this group was gallstone.The NAFLD group consisted of 378 patients and the main etiology was hyperlipidemia.The incidence of mild AP,moderately severe AP,and severe AP was 77.30%,18.3%,and 4.3%in the non-NAFLD group and 58.2%,33.9%,and 7.9%in the NAFLD group,respectively.There were significant differences between the two groups according to the severity of AP(P<0.001).In addition,the Ranson and BISAP scores as well as the incidence of SIRS and organ failure in the NAFLD group were higher than those in the non-NAFLD group(all P<0.05).The patients were further divided into non-NAFLD,mild-NAFLD,and moderate-severe NAFLD(M+S-NAFLD)groups.The results showed that the severity of AP increased gradually from the non-NAFLD group to the M+S-NAFLD group.In addition,the incidence rates of SIRS and organ failure showed an upward trend with the aggravation of fatty liver severity.Multivariate logistic analysis showed that patients with NAFLD,especially those with M+S-NAFLD,had higher risks of SIRS and organ failure.Conclusions:Compared with non-NAFLD,NAFLD has a clinically relevant impact on the severity of AP and may be an early prognostic parameter for patients with AP.Part 2.Association of the hypertriglyceridemic waist phenotype and prognosis of patients with acute pancreatitisBackground:The aim of this study was to evaluate the effect of a simple visceral obesity phenotype,known as the hypertriglyceridemic waist phenotype(HTGW)and its quantitative indicator waist circumference index on the severity of acute pancreatitis.Materials and Methods:A retrospective analysis was made of AP patients diagnosed in the Affiliated Hospital of Yangzhou University from January 2013 to December 2016.Diagnosis and severity analysis of acute pancreatitis(AP)were determined according to the Atlanta classification guidelines,revised in 2012.We considered the hypertriglyceridemic waist(HTGW)phenotype as characterized by increased waist circumference and elevated triglyceride concentrations.We investigated the association between the AP severity and HTGW phenotype including waist circumference index.Results:The HTGW phenotype was significantly associated with systemic inflammatory response syndrome(SIRS),organ failure,and severe acute pancreatitis(SAP).The incidence of SIRS,organ failure(All types of organ failure)and SAP was higher in patients with HTGW phenotype after admission.The median waist circumference index(WTI)and demonstration of the HTGW phenotype were positively correlated with the severity of AP.In addition,multivariate logistic analysis showed that patients with the HTGW phenotype had 1.664 times the risk of organ failure and 1.891 times the risk of SIRS,compared with the other groups.Conclusion:Upon admission,the AP patients with HTGW phenotype have more severe course than others.The HTGW phenotype was strongly associated with AP in patients.This phenotype,including WTI,might be a simple method for evaluating individuals at high risk of severe acute pancreatitis.