Association between triglyceride, lipase and organ failure in hypertriglyceridemia-associated acute pancreatitis

Background Lipolysis of triglyceride has been shown to increase the severity of hypertriglyceridemia-associated acute pancreatitis (HTG-AP). This pathophysiological process relies on the elevation of triglyceride and lipase levels. This study aimed to determine the relationship between serum triglycerides, lipase, and the organ failure-free days (OFFDs)in HTG-AP. Methods This is a secondary analysis of a prospective multicenter HTG-AP registry. Patients were stratified into quartiles (Q1-Q4) based on the triglyceride-lipase index (triglyceride × lipase) interquartile ranges. The primary outcome was organ failure-free days within 14 days. Secondary outcomes included new-onset/persistent organ failure, ICU-free days, and hospital duration. Adjusted negative binomial regression and restricted cubic spline (RCS) models were used to evaluate the associations between the triglyceride-lipase index and organ failure. Confounders were selected via directed acyclic graphs. Results 310 patients from 18 centers were included. Adjusted analysis showed patients in Q2 had similar OFFDs vs. Q1 (adjusted incidence rate ratio [aIRR] 0.96, 95%CI 0.88–1.05). 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. RCS revealed a nonlinear relationship between the triglyceride-lipase index and the time to resolution of organ failure; time to organ failure resolution significantly increased when the triglyceride-lipase index exceeded 11783 mmol × U/L². Conclusions Concurrent elevation of circulating triglyceride and lipase, evidenced by elevated triglyceride-lipase index, is associated with increased incidence and duration of organ failure among patients with HTG-AP. This suggests that future trials should investigate lipolysis as a potential treatment target in patients with HTG-AP. Registration: This retrospective observational study uses data collected from the PERFORM registry. The PERFORM registry was approved by the local ethics committees of the participating hospitals and registered with the Chinese Clinical Trial Registry (ChiCTR2000039541) before enrolment commenced.