ESA-SRB-AOTA 2019

Severe hypertriglyceridemia-associated acute pancreatitis: a prospective study of incidence and management. (#552)

Hong Lin Evelyn Tan 1 2 , Georgina McDonald 1 3 , Alexander Payne 3 , William Yu 3 , Zahrul Ismadi 4 , Amanda Caswell 1 4 , Huy Tran 1 4 , Jon Gani 1 5 , Katie Wynne 1 2
  1. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  2. Department of Diabetes & Endocrinology, John Hunter Hospital, Newcastle, NSW, Australia
  3. Department of Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
  4. Department of Clinical Chemistry, John Hunter Hospital, New Lambton Heights, NSW, Australia
  5. Department of Surgery, John Hunter Hospital, New Lambton Heights, NSW, Australia

Introduction Hypertriglyceridemia-associated acute pancreatitis (HTGAP) is thought to account for 2-6% of acute pancreatitis (AP) and has been associated with increased severity and morbidity.1 Despite being the third most common cause of AP, triglyceride levels are not routinely measured. This study prospectively measured triglyceride levels to establish incidence in a tertiary Australian centre.

Aims and Methods A prospective cohort was collated over 18 months in a tertiary referral hospital. Adults with AP had admission triglyceride levels measured if lipase was 3x the upper reference limit. HTGAP was defined as AP with triglycerides >11.1mmol/L.1,2 Incidence, severity and management strategies were recorded.

Results Of 301 episodes of AP, 253(84%) had triglycerides measured and were included. HTGAP was diagnosed in 10 of 253(4%) AP cases. Type 2 diabetes (n=6) and overweight status (BMI>25kg/m2, n=6) were common. Alcohol misuse (n=4) and gallstones (n=3) may have contributed to AP. Severe hypertriglyceridemia was present in the HTGAP group (49.0±10.2 vs. 1.8±0.1mmol/L). Despite their age (49±2 vs. 54±1years, p=0.36), the HTGAP group had longer hospital admissions (8.0±1.9 vs. 5.4±0.7days, p=0.03). ICU admissions were significantly increased (OR 15, 95% CI 4-58) in the HTGAP group (5/10 vs. 15/243 admissions, p<0.001) and constituted 25%(5/20) of total ICU admissions for AP. All patients were managed with a low-fat (<30g) diet. Four patients received intravenous insulin with resolution of hypertriglyceridemia over 3-5 days; one patient with diabetes had mild hypoglycaemia requiring 10% dextrose infusion. Oral therapy was commenced prior to discharge (statin n=7, fibrate n=5).

Conclusion HTGAP occurred in 4% of AP cases and was associated with high risk of ICU admission and longer length of stay. Intravenous insulin results in a rapid reduction of triglyceride levels.2 Plasmapheresis, albeit efficacious in reducing triglyceride levels, has complications and is not recommended.2 A novel management protocol is proposed for testing in future studies.

  1. Vipperla K, Somerville C, Furlan A, Koutroumpakis E, Saul M, Chennat J, et al. Clinical Profile and Natural Course in a Large Cohort of Patients With Hypertriglyceridemia and Pancreatitis. J Clin Gastroenterol. 2017;51(1):77-85.
  2. Adiamah A, Psaltis E, Crook M, Lobo DN. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis. Clin Nutr. 2018;37(6 Pt A):1810-22.