Triglyceride-lowering therapies in hypertriglyceridemia-associated acute pancreatitis in China: a multicentre prospective cohort study
Jing Zhou, Zuozheng Wang, Qinghong Liu, Longxiang Cao, Enrique de‐Madaria, Gabriele Capurso, Christian Stoppe, Dong Wu, Wei Huang, Yingjie Chen, Siyao Liu, Donghuang Hong, Yun Sun, Zhenguo Zeng, Kaixiu Qin, Haibin Ni, Yi Sun, Yue Long, Feng Guo, Xiaofeng Liu, Zheng Xisheng, Guoxiu Zhang, Xiangcheng Zhang, Kai Zhou, Yizhe Chen, Qinghai Jiao, Xinsen Zou, Xiang Luo, Gang Li, Bo Ye, Chao Li, Lanting Wang, Shuai Li, John A. Windsor, Yuxiu Liu, Zhihui Tong, Weiqin Li, Lu Ke, Wenjian Mao, Jiajia Lin, Mingfeng Huang, Mengjie Lu, Yan Chen, Baiqiang Li, Tao Chen, Fang Shao, Nonghua Lv, Yin Zhu, Liang Xia, Wenhua He, Zhenping Chen, Xinting Pan, Qingyun Zhu, Youdong Wan, Mei Hong, Kang Li, Miao Chen, Chengjian He, Hongyi Yao, Zigui Zhu, Weili Gu, Weihua Lü, Jingyi Wu, Feng Zhou, Shumin Tu, Long Fu, Bing Xue, Xiaofei Huang, Dandan Zhou, Lening Ren, Dahuan Li, Xiangyang Zhao, Wei Zhao, Xiaomei Chen, Junli Sun, Keke Xin, Weiwei Chen, Qingcheng Xu, Jingchun Song, Qingbo Zeng, Min Shao, Dongsheng Zhao, Jian‐Feng Tu, Hongguo Yang, Bin Wu, Huaguang Ye, Mingzhi Chen, Mei Yang, Hong Gao, Qiang Li, Lijuan Zhao, Guobing Chen, Yafei Li, Honghai Xia, Dongliang Yang, Shusheng Zhou, Jiyan Lin, Songjing Shi, Weijie Yao, Shan Xu
Abstract
BACKGROUND: No specific triglyceride-lowering therapy is recommended in patients with hypertriglyceridemia-associated acute pancreatitis (HTG-AP), primarily because of the lack of quality evidence. This study aimed to describe practice variations in triglyceride-lowering therapies for early HTG-AP patients and assess whether more rapid triglyceride decline is associated with improving organ failure. METHODS: This is a multicentre, prospective cohort study recruiting HTG-AP patients with elevated plasma triglyceride (> 11.3 mmol/L) admitted within 72 h from the onset of symptoms. Patients were dichotomised on study day 3 into either target reaching (plasma triglyceride ≤ 5.65 mmol/L) or not. The primary outcome was organ failure-free days (OFFD) to 14 days of enrolment. The association between target-reaching and OFFD was modelled. Additionally, the slope in plasma triglyceride over the first three days in response to treatment was calculated, and its association with OFFD was assessed as a sensitivity analysis. RESULTS: Among the 300 enrolled patients, 211 underwent exclusive medical treatment, and 89 underwent various blood purification therapies. Triglyceride levels were available in 230 patients on study day 3, among whom 122 (53.0%) had triglyceride levels of ≤ 5.65 mmol/l. The OFFD was not different between these patients and those in whom plasma triglyceride remained > 5.65 mmol/L [median (IQR): 13 (10-14) vs. 14 (10-14), p = 0.46], even after adjustment for potential confounders. For the decline slopes, there was no significant change in OFFD with a steeper decline slope [risk difference, - 0.088, 95% CI, - 0.334 to 0.158, p = 0.48]. CONCLUSIONS: Triglyceride-lowering therapies vary greatly across centres. More rapid triglyceride decline was not associated with improving incidence and duration of organ failure.