Clinical Characteristics Of Hypertriglyceridemia Acute Pancreatitis Complicated With Diabetic Ketoacidosis

Objective:To analyze the differences of biochemical indexes and characterists of patients with Hypertriglyceridemic Pancreatitis(HTG-AP)combined with Diabetic Ketoacidosis(DKA),and to improve the understanding and d clinical diagnosis and treatment level of clinicians on patients with HTG-AP combined with DKA Methods:The basic information of the 131 patients with HTGP and DKA admitted to the digestive internal medicine,the emergency department and the intensive care unit(ICU)in the First Clinical Hospital of Jilin University from May 2019 to February2021 were retrospectively collected.The patients were divided into DKA group and non-DKA group according to the combination of DKA,and basic information,laboratory data,clinical complications,clinical scores,treatment measures,disease outcomes and other relevant clinical data of the two groups were collected,and univariate analysis and multivariate Logistic regression analysis were conducted to study the independent risk factors of HTG-AP combined with DKA.Draw the receiver operating characteristic(ROC)curve and calculate the area and the curve(AUC)to evaluate the predictive performance of the indicators Results:1.The results of univariate analysis showed that: DKA group body mass index(BMI),history of diabetes,disorders of consciousness,triglyceride(TG),serum amylase(AMY),blood glucose,Glycosylated hemoglobin(Hb A1c),procalcitonin(PCT)and anion gap(AG)were higher than those in non-DKA group,and the comparison between the two groups was statistically significant(P<0.05).The carbondioxide combining power(CO2-CP),calcium(Ca2+),albumin(ALB)and potential of hydrogen(PH)in the DKA group were lower than those in the non-DKA group.The comparison between the two groups was statistically significant(P<0.05).2.Taking factors with statistical differences in univariate analysis as independent variables and HTG-AP combined with DKA as dependent variables,the results of multivariate logistic regression analysis showed that: BMI(OR=0.661,P=0.037),TG(OR=0.818,P=0.046)and Hb A1c(OR=0.46,P= 0.049)were independent risk factors for HTG-AP combined with DKA,CO2-CP(OR=1.486,P=0.018)can be regarded as an independent protective factor of the disease.3.The continuity variables BMI,TG,Hb A1 c and CO2-CP were statistically significant to draw ROC curves.The results showed that the AUC value of CO2-CP was 0.879,the sensitivity was 90.4%,the specificity was 75.9%,and the Yoden index was 0.663.The AUC value of Hb A1 c was 0.804,the sensitivity was 64.4%,the specificity was 84.5%,and the Yoden index was 0.489.The AUC value of BMI was0.703,the sensitivity was 64.4%,the specificity was 67.2%,and the Yoden index was0.316.The AUC value of TG was 0.629,the sensitivity was 52.1%,the specificity was74.1%,and the Yoden index was 0.262.The AUC value of the combined diagnosis of the above indicators was 0.932,the sensitivity was 94.5%,the specificity was 81%,and the Yuden index was 0.756.4.The incidence of systemic inflammatory syndrome(SIRS),the incidence of severe acute pancreatitis(SAP),acute physiology and chronic health evaluation II(APACHE II),bedside index of severity in acute pancreatitis,(BISAP index),Ranson score and continuous renal replacement therapy(CRRT)rate showed statistically significant differences(P<0.05);The DKA group had higher cumulative fluid intake at 24 h,48h and 72 h after admission than the non-DKA group,and the difference was statistically significant(P<0.05);The length of stay,total hospitalization cost and average daily hospitalization cost in DKA group were higher than those in non-DKA group,and the difference between the two groups was statistically significant(P<0.05).Conclusions:1.In this study,BMI,TG and Hb A1 c were considered as independent risk factors for HTG-AP complicated with DKA,and CO2-CP could be regarded as independent protective factors for the disease.Monitoring the changes of the above indicators in HTG-AP patients and timely correction can help prevent the occurrence of DKA and improve the prognosis of patients.2.The combined prediction of BMI,TG,Hb A1 c and CO2-CP was more accurate than single factor prediction.3.When HTG-AP is combined with DKA,the early circulation capacity is obviously insufficient,and DKA increases the severity of AP and even leads to persistent organ dysfunction.4.Htg-Ap patients with DKA have long hospitalization time and heavy economic burden.5.Active control of body weight,blood lipid and blood glucose levels within the normal range is beneficial to prevent the occurrence of diseases and improve the prognosis.