Influence of serum triglyceride level on the prognosis of acute biliary pancreatitis / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the influence of serum triglyceride (TG) level on the outcome of acute biliary pancreatitis (ABP). MethodsA retrospective analysis was performed for 249 ABP patients who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019, and the patients were divided into normal blood lipid group(n=156) and mild(n=25), moderate(n=44), and severe(n=24) hyperlipidemia groups. The patients’ data were collected for analysis. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Dunn-Bonferroni test was used for further comparison between two groups. The chi-square test was used for comparison of nominal categorical variables between multiple or two groups; the Kruskal-Wallis H test was used for comparison of ordinal categorical variables between multiple groups, and the Mann-Whitney U rank sum test was used for further comparison between two groups. A multivariate logistic regression analysis was used to investigate the influencing factors for organ failure and infectious pancreatic necrosis (IPN), and the receiver operating characteristic (ROC) curve was used to evaluate the value of different indices in predicting severe acute pancreatitis (SAP). ResultsThere were significant differences in age and BISAP between four groups(χ2=25.057， 10.430, all P＜0.05) . Compared with the normal blood lipid group, the severe hyperlipidemia group had a significantly higher proportion of patients with IPN or multiple organ failure syndrome (MODS) (both P＜0.05), and the moderate hyperlipidemia group had a significantly higher proportion of patients with MODS (P＜0.05), while the severe hyperlipidemia had a significantly higher proportion of patients with systemic inflammation reaction syndrome than the other three groups (all P＜005). Compared with the normal blood lipid group, the moderate and severe hyperlipidemia groups had a significant increase in the risk of MODS (moderate hyperlipidemia group odds ratio ［OR］=3.500, 95% confidence interval ［CI］ 1.193-10.270, P＜0.05; severe hyperlipidemia group OR=6.167, 95%CI 1921-19.792, P＜0.05), and after adjustment, the risk of MODS in the severe hyperlipidemia group was 3.430 times that in the normal blood lipid group (95%CI 1.198-9.825, P=0.022). The severe hyperlipidemia group had a significant increase in the risk of IPN (OR=4.351, 95%CI 1.719-11.008, P＜0.05), and after adjustment, the risk of IPN in the severe hyperlipidemia group was 5.819 times that in the normal blood lipid group (95%CI 1.489-22.745, P＜0.05). Blood lipids had a good value in predicting SAP, with an area under the ROC curve of 0.626 (95%CI 0.530-0.723, P=0.008). ConclusionCompared with the ABP patients with normal TG, ABP patients with elevated TG tend to have a younger age, more complications, and a higher mortality rate, especially those with a TG level of ＞5.65 mmol/L, and therefore, antihyperlipidemic treatment for such patients should be taken seriously to improve their survival rate and prognosis.