Timely reduction of triglyceride in patients with different severity of hypertriglyceridemia-associated acute pancreatitis：secondary analysis of a multicenter, prospective cohort study

Objectives It is controversial whether rapid lowering of triglyceride (TG) levels was associated with clinical benefits in patients with hypertriglyceridemia-associated acute pancreatitis (HTG-AP). Particularly, patients with different severity of disease may respond differently to TG-lowering therapy. In this study, we aimed to explore the association between timely reduction in serum TG levels and organ failure in patients with different severity of HTG-AP. Methods This is a secondary analysis of data from a multicenter, prospective registry recruiting HTG-AP patients (plasma TG levels > 11.3mmol/L at admission) admitted within 72 hours from the onset of symptoms. Patients were dichotomized into either target reaching (TG ≤ 5.65 mmol/L on study day 3) or not. The primary outcome was the presence of organ failure on day 14. The association between target-reaching and the primary outcome was modelled. Furthermore, subgroup analyses were conducted based on the disease severity of HTG-AP patients at enrollment (with vs. without organ failure, predicted severe vs. predicted non-severe based on APACHEII score). Results Overall, 413 patients were included for analysis, of whom 192 (46.5%) patients reached the target on day 3. For the overall study cohort, there was no significant difference in presence of organ failure at day 14 between patients reaching the target or not (3.1% vs. 6.8%, p  = 0.091). In the subgroup of HTG-AP patients with organ failure at enrollment, compared to patients with TG > 5.65mmol/L on day 3, patients who reached the target had significantly lower presence of organ failure at day 14 (7.8% vs. 22%, p  = 0.039), and the results remain unchanged after adjustment for potential confounders ( p  = 0.027). In the subgroup of more severe HTG-AP patients (APACHE II ≥ 8), there was also lower presence of organ failure at day 14 (5.8% vs. 17.7%, p = 0.044) and lower incidence of IPN within 60 days (1.4% vs. 11.3%, p = 0.036) in patients who reached the target. Conclusion Timely reduction of serum TG levels was associated with decreased presence of organ failure at day 14 in patients with more severe HTG-AP.