The Impact Of The Serum Triglyceride Level On The Prognosis Of Patients With Severe Acute Pancreatitis

Acute pancreatitis is a common inflammatory disease of the pancreas that can cause local damage,systemic inflammatory response syndrome and organ failure.The symptom of the most patients is mild and can return to normal in 1-2week.A small number of patients can develop to severe acute pancreatitis and have a high mortality.With the change of eating habits in recent years,the incidence of hyperlipidemia is increasing,the incidence of acute pancreatitis caused by hypertriglyceridemia is increasing year by year.And it has exceeded the incidence of alcoholic acute pancreatits and has become the second most common cause of acute pancreatitis.Patients who are diagnosed hypertriglyceridemic acute pancreatitis are younger,more likely to have metabolic syndrome,have higher mortality,and likely to have a worse prognosis than those with other causes.However the relationship between the level of serum triglyceride and prognosis and severity are still unclear.And there is no uniform standard for the treatment of hypertriglyceridemia acute pancreatitis.The initial management of hypertriglyceridemic pancreatitis is the same as for all other causes of acute pancreatic,including a fastening state,gastrointestinal support,intensive intravenous hydration and analgetic treatment,nutritional support,and inhabitation of pancreatic enzyme secretion.The special treatment of the hypertriglyceridemic pancreatitis mainly refer to lowering blood triglyceride level and preventing systemic inflammatory response syndrome.It has been reported that early rapid control of triglyceride level below 5.65mmmol/L can significantly improve the prognosis of hypertriglyceridemia acute pancreatitis.But there are no prospective randomized controlled trials to assess the effective and safety by early intervention of triglyceride level.Based on above background,this study aims to investigate the relationship between serum triglyceride and moderate severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP),To investigate the effect of the rate of serum triglyceride deline on the prognosis of patients with moderate severe and severe hyperlipidemic acute pancreatits,so as to provide evidence on early assessment condition and effective treatment of hypertriglyceridemia acute pancreatitis and improve the prognosis of hypertriglyceridemia acute pancreatitisPartⅠ The Impact of Serum Triglyceride on the Prognosis of Patients with Moderate Severe and Severe Acute PancreatitisObjective To investigate the impact of serum triglyceride(TG)on the prognosis of patients with moderate severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP).And to provide clinical evidence for early rapid assessment of disease and improve prognosis.Methods A retrospective analysis was made by reviewing the clinical data of 165 patients with first diagnosis of MSAP and SAP from January 2015 to June 2018.According to triglyceride level which is higher than 1.8mmol/L or not,patients were divided into normal group(TG≤1.8mmol/L),elevated group(TG>1.8mmol/L).And the elevated group was divided into mild to moderate group(1.8<TG≤11.3 mmol/L)and severe group(TG>11.3 mmol/L).Analyse the general conditions,blood amylase,serum calcium,blood lactate dehydrogenase(LDH),mortality,incidence of pseudocyst、Multiple Organs Dysfunction Sydrome(MODS)、mechanical ventilation、recurrence,pancreatic necrosis and infection rate,incidence of Systemic Inflammatory Response Syndrome(SIRS)and hospitalization day.Compare Ranson,Marshall,BISAP,APACHE II score difference.Logistic regression analysis were performed on whether SIRS occurred and whether MODS occurred as a dependent variable.Results(1)Compared with TG normal group,the mean age of patients in the TG elevated group was smaller(42.4±10.8 vs 57.8±15.8,P<0.05),the male ratio was greater(76.1% vs 54.8%,P<0.05),the Body Mass Index(BMI)was higher.And they are more likely to have diabetes(40.2% vs 11.0%,P<0.01).The mortality rate 、incidence of SIRS、the recurrence rate are higher than the normal group(13% vs 4%,P=0.047;60.9% vs 34.2%,P=0.000;21.7% vs 5.5%,P=0.003).Moreover patients in TG elevated group are more likely to have pseudocysts(53% vs 36%,P=0.024).The Marshall score and APACHE II score are also higher than TG normal group(P=0.009 and P=0.044),The levels of serum calcium and amylase in the patients with elevated TG are lower than those in normal group(P<0.01),and the level of blood lactate dehydrogenase(LDH)are higher than those in normal group(614 vs 436,P<0.01);In addition,there was no statistic difference in hospitalization days,mechanical ventilation rate,pancreatic necrosis and infection rate,severity of disease,ranson score and BISAP score between the two groups(P>0.05).(2)Triglyceride stratified analysis showed that compared with the normal TG group and the mild to moderate TG group,the mortality rate(23.9% vs 2.2%,P<0.05;23.9% vs 4.1%,P<0.05)、the SAP ratio(47.8% vs 21.9%,P<0.05;47.8% vs 6.5%,P<0.05)、the incidence of SIRS(73.9% vs 34.2%,P<0.05;73.9% vs 47.8%,P<0.05)、the MODS rate(56.5% vs 21.9%,P=0.000;56.5% vs 19.6%,P=0.000)were higher in severe TG group.The mechanical ventilation rate in severe TG group was significantly higher in the mild to moderate TG group,however there was no significant difference when compared with TG normal group(26.1% vs 11.0%,P>0.05).The recurrence rate in severe TG group was significantly higher when compared with TG normal group(28.3% vs 5.5%,P<0.01).But when compared with mild to moderate TG group,there was no significant difference.There was also no difference in the hospitalization days between the three groups(P=0.238).(3)Multivariate regression analysis showed that triglyceride was an independent risk factor for AP patients who occur MODS or SIRS.Conclusion The higher the triglyceride at the time of admission or onset,the higher mortality rate,recurrence rate among MSAP and SAP patients;the worse the prognosis,and the more likely they are complicated with pseudocysts.TG is an independent risk factor for AP patients who occur MODS or SIRS.Part Ⅱ The impact of blood triglyceride decline rate on the prognosis of patients with moderate severe and severe hyperlipidemic acute pancreatitisObjective To investigate the impact of blood triglyceride decline rate on the prognosis of patients with moderate severe and severe hyperlipidemic acute pancreatitis(HLAP),so as to provide clinical evidence on whether it is needed to early intervened blood triglyceride level.Methods A retrospective analysis was made by reviewing the clinical data of 90 patients with diagnosis of moderate severe and severe hyperlipidemic acute pancreatitis from January 2016 to December 2018.The rate was defined by the level of triglyceride decline.The triglyceride level decrease to≤5.65mmol/L,which was defined as triglyceride rapidly decrease group(RD group,n=54).Those who did not meet the above criteria were defined as triglyceride slowly decrease group(SD group,n=36).To separately analyze the impact of the triglyceride decrease rate on hospitatalization days,systemic inflammatory response syndrome(SIRS)duration,mechanical ventilation rate,pancreatic necrosis and infection rate,mortality,incidence of pseudocysts,multiple organ dysfunction syndrome(MODS)incidence and ratio of MSAP progression to SAP among moderate severe and severe hyperlipidemia acute pancreatitis patients.Results(1)There was no statistic difference in age,gender,TG level at admission,APACHE II score,diabetes,amylase,and lactate dehydrogenase(LDH)between rapidly decrease group(RD)and slowly decrease group(SD)(P value all>0.05).The two groups were comparable.The average triglyceride level in the RD group after 72 hours of admission was(3.4±1.1)mmol/L.The average triglyceride level in the SD group after 72 hours of admission was(8.5±5.0)mmol/L.There were statistical differences between the two groups(P<0.01).(2)Among MSAP patients,the average hospitalization days and duration of SIRS in RD group were lower than those in the SD group,and there was a significant difference between the two groups(13d vs 21 d,P<0.05;6d vs 3d,P=0.024).The proportion of patients who progress to SAP was significantly lower than that of the SD group.There was a significant difference between the two groups(16.1% vs 43.5%,P=0.027).The incidence of MODS in the SD group was statistically difference higher than that in the RD group(43.5% vs 16.1%).The mortality rate in the RD group was lower than in the SD group,but there was no statistically significant difference between the RD group and SD group(3.2% vs 17.4%,P>0.05).The incidence of pseudocysts and pancreatic necrotic infection,the mechanical ventilation rate in the RD group were also lower than those in SD group.There was no statistical difference between the two groups(77.4% vs 87.0% P>0.05;12.9% vs 34.8%,P>0.05;3.2% vs 21.7%,P>0.05).(3)Among SAP,the duration of SIRS in the RD group was significantly lower in the SD group(4d vs 10 d,P=0.034).The average hospital stay in the RD group was lower than in the SD group(25d vs 28 d,P>0.05).The mortality rate of the RD group was lower than the SD group,but the difference between the two groups was not statistically significant(23.5% vs 42.1%,P>0.05).The pancreatic necrosis and infection rate,the mechanical ventilation rate in the RD group were also lower than those in SD group.But there was no difference between the RD group and SD group(29.2% vs 57.9%;35.3% vs 47.4%,P value all>0.05).Conclusion For MSAP patients who complicated with hyperlipidemia,early rapidly decrease triglyceride level can shorten the duration of SIRS and hospitalization,reduce the occurrence of MODS,and reduce the progression of MSAP to SAP.For SAP patients with hyperlipidemia,early rapidly decrease triglyceride level can shorten the duration of SIRS,but can not significantly reduce the incidence of mortality and complications in moderate severe and severe hyperlipidemia patients.