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

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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.

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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.

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Authors and Affiliations

  1. Center for Pancreatic Care, Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, 1526 N Edgemont Ave, 7th Floor, Los Angeles, CA, USA

    Bechien U. Wu

  2. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    Michael Batech, Lewei Duan & Wansu Chen

  3. Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Elizabeth Y. Dong

  4. Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh PA, USA

    Dhiraj Yadav

Authors
  1. Bechien U. Wu
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  2. Michael Batech
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  3. Elizabeth Y. Dong
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  4. Lewei Duan
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  5. Dhiraj Yadav
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  6. Wansu Chen
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Contributions

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.

Corresponding author

Correspondence to Bechien U. Wu.

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

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Appendix

Appendix

See Table 4.

Table 4 Concomitant medication use at any point during follow-up by whether the patient was ever readmitted
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Wu, B.U., Batech, M., Dong, E.Y. et al. Influence of Ambulatory Triglyceride Levels on Risk of Recurrence in Patients with Hypertriglyceridemic Pancreatitis. Dig Dis Sci 64, 890–897 (2019). https://doi.org/10.1007/s10620-018-5226-x

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  • DOI: https://doi.org/10.1007/s10620-018-5226-x

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