Association of metabolic and lipid indices with severity among patients with acute pancreatitis: A 10-year prospective registry-based cohort study with focus on hypertriglyceridemia-associated acute pancreatitis.

BACKGROUND

The distribution of lipid-related indices and the relationship between metabolic and lipid indices other than triglycerides (TG) and the severity of hypertriglyceridemia-associated acute pancreatitis (HTG-AP) severity remains unclear.

OBJECTIVE

To investigate the clinical characteristics and lipid profiles of AP with different etiologies, and to explore the relationship between metabolic/lipid indices and the severity of HTG-AP.

METHODS

We conducted a monocentric cohort study using prospectively collected data on AP patients who were admitted < 48 h since abdominal pain onset between September 1, 2013 and June 6, 2022. Lipid-related indices distribution among AP of three different etiologies was described. A Restricted Cubic Spline (RCS) model was conducted to investigate the nonlinear dose-response relationships between metabolic and lipid-related indices and severe acute pancreatitis (SAP) among HTG-AP patients. If results did not satisfy nonlinear relationship, multivariable logistic regression analysis was utilized.

RESULTS

In total, 3878 AP patients met the inclusion criteria, 2327 (60.0 %) were classified as HTG-AP. In < 45 age group, the incidence of organ failure was 28.9 % in HTG-AP, higher than those caused by biliary (19.3 %) and alcohol (23.7 %) etiologies. HTG-AP patients demonstrated lower levels of low-density and high-density lipoprotein cholesterols (LDL-C and HDL-C), and higher levels of other lipid indices. RCS showed a nonlinear relationship between TG/HDL-C and risk of SAP (P < 0.05 for nonlinear test), with a turning point at 40. Other indices exhibit a linear relationship. Compared to patients with lower values, higher TyG index (>9.90), FIB-4 score (>1.54), hemoglobin (≥143 g/L), and TG/LDL-C ratio (>21) were significantly associated with increased risk of SAP, with adjusted ORs of 1.79 (95 % CI: 1.17-2.74), 1.77 (95 % CI: 1.15-2.72), 1.70 (95 % CI: 1.45-2.55), and 2.36 (95 % CI: 1.41-4.01).

CONCLUSIONS

Among HTG-AP patients, TyG index, FIB-4 score, hemoglobin, TG/LDL-C and TG/HDL-C indices may have value for early stratifying patients prone to SAP.