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Influence of Ambulatory Triglyceride Levels on Risk of Recurrence in Patients with Hypertriglyceridemic Pancreatitis

  • Bechien U. Wu
  • Michael Batech
  • Elizabeth Y. Dong
  • Lewei Duan
  • Dhiraj Yadav
  • Wansu Chen
Original Article
  • 60 Downloads

Abstract

Background and Aims

To evaluate impact of ambulatory triglyceride levels on risk of recurrent pancreatitis in patients with hypertriglyceridemic pancreatitis.

Methods

We conducted a longitudinal retrospective cohort study of patients with serum triglyceride level ≥ 500 mg/dL during index hospitalization for acute pancreatitis within a regional integrated healthcare system between 2006 and 2013 (follow-up through 2015). Cases were identified based on combination of diagnosis codes and serum amylase/lipase. We used multivariable robust Poisson regression to determine independent effect of baseline (first outpatient) triglyceride measurement on risk of recurrent pancreatitis. Ambulatory triglyceride levels were categorized as normal (0–200 mg/dL), moderately elevated (201–500 mg/dL), and highly elevated (> 500 mg/dL). We further assessed factors related to likelihood of normalization of serum triglycerides (< 200 mg/dL) in the outpatient setting.

Results

One hundred and fifty-one patients met study inclusion criteria with median follow-up of 3 years. Overall, 45 (29.8%) patients experienced at least 1 recurrent attack with 25 (16.6%) experiencing multiple episodes. In multivariable analysis, patients that continued to have moderately elevated ((adjusted rate ratio RR 5.47 (95% CL 1.80, 16.65)) as well as highly elevated (RR 8.45 (2.55, 27.96)) triglycerides were at increased risk of disease recurrence compared to patients that achieved normalization. Patients with triglyceride measurement performed within 30 days from discharge were more likely to achieve normalization, 40 versus 26%, p = 0.03.

Conclusions

For patients with hypertriglyceridemic pancreatitis, even modest elevation in subsequent triglyceride levels was associated with increased risk of recurrence. Future efforts should focus on ensuring timely care in the outpatient setting with a goal of normalizing triglycerides.

Keywords

Recurrent acute pancreatitis Hypertriglyceridemia Pancreatitis 

Notes

Acknowledgments

A portion of this study was funded through a research grant from Shire pharmaceuticals, Lexington MA. The sponsor did not have any role in data analysis, interpretation or manuscript preparation/review.

Author’s contribution

Dr. Wu contributed to study concept, design, interpretation of data, manuscript preparation, and revision. Dr. Batech contributed to data collection, data analysis, data interpretation, and manuscript preparation. Dr. Dong contributed to data collection, data interpretation, and critical revision of manuscript. Dr. Yadav contributed to study concept, study design, interpretation of data, and manuscript revision. Dr. Chen contributed to study concept, data analysis, data interpretation, and revision of manuscript.

Compliance with ethical standards

Conflict of interest

All authors affirm they have no relevant financial conflicts to disclose.

Supplementary material

10620_2018_5226_MOESM1_ESM.docx (29 kb)
Supplementary material 1 (DOCX 28 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Bechien U. Wu
    • 1
  • Michael Batech
    • 2
  • Elizabeth Y. Dong
    • 3
  • Lewei Duan
    • 2
  • Dhiraj Yadav
    • 4
  • Wansu Chen
    • 2
  1. 1.Center for Pancreatic Care, Division of GastroenterologyKaiser Permanente Los Angeles Medical CenterLos AngelesUSA
  2. 2.Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaUSA
  3. 3.Department of Internal MedicineKaiser Permanente Los Angeles Medical CenterLos AngelesUSA
  4. 4.Division of GastroenterologyUniversity of Pittsburgh Medical CenterPittsburgh PAUSA

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