Background: Lipolysis of triglyceride has been shown to increase the severity of hypertriglyceridemia-associated acute pancreatitis (HTG-AP). This relies on the concurrent elevation of circulating triglyceride and lipase levels. This study aimed to determine the relationship between serum triglyceride, lipase, and the incidence and duration of organ failure in patients with HTG-AP.
Methods: This is a secondary analysis of a prospective multicenter registry of patients with HTG-AP who had clinically worrisome features1. Using the interquartile range (IQR) values of the triglyceride-lipase index (triglyceride × lipase), the study patients were stratified into 4 groups (Q1 to Q4). The primary outcome was organ failure-free days (OFFDs) to 14 days of enrollment. Secondary outcomes included new-onset organ failure, persistent organ failure, ICU-free days to 14 days of enrollment, and hospital duration. Negative binomial regression models and restricted cubic spline models were used to evaluate the association between the triglyceride-lipase index and incidence and duration of organ failure. Confounders included for adjustment were selected based on the directed acyclic graph.
Results: A total of 310 patients from 18 centers were included. After adjusting for potential confounders, the results showed that compared with patients in Q1, patients in Q2 had similar OFFDs (adjusted incidence rate ratio [aIRR] 0.96, 95%CI 0.88-1.05), while patients in Q3 (aIRR 0.90, 95%CI 0.83-0.99) and Q4 (aIRR 0.89, 95%CI 0.81-0.98) had significantly fewer OFFDs. Restricted cubic spline models revealed a nonlinear relationship between the triglyceride-lipase index and time to organ failure resolution. The time to organ failure resolution was significantly increased when the triglyceride-lipase index exceeded 11783mmol×U/L2.
Conclusion: Concurrent elevation of circulating triglyceride and lipase, evidenced by elevated triglyceride-lipase index, is associated with an increased incidence and duration of organ failure in patients with HTG-AP. This suggests that future trials should investigate lipolysis as a potential treatment target in patients with HTG-AP.