Early predictors of hyperlipidemic acute pancreatitis

Cao,Xi; Wang,Huai‑Ming; Du,Hai; Chen,Er‑Xia; Yang,Xiu‑Feng; Wang,Shi‑Long; Ding,Ya; She,Zhan‑Fei

doi:10.3892/etm.2018.6713

Early predictors of hyperlipidemic acute pancreatitis

Authors:
- Xi Cao
- Huai‑Ming Wang
- Hai Du
- Er‑Xia Chen
- Xiu‑Feng Yang
- Shi‑Long Wang
- Ya Ding
- Zhan‑Fei She
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Affiliations: Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China, CT‑MRI Room, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
Published online on: September 10, 2018 https://doi.org/10.3892/etm.2018.6713
Pages: 4232-4238

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Abstract

The present study aimed to investigate early risk factors for hyperlipidemic acute pancreatitis (HLAP) in order to open up novel routes for its prevention and treatment. Demographics, laboratory data obtained within 48 h, enhanced computed tomography (CT) imaging data and the modified CT severity index (MCTSI) for 111 patients with HLAP who were assessed at Ordos Central Hospital (Ordos, China) between January 2015 and October 2017 were retrospectively analyzed. Of these, 17 patients progressed to infectious pancreatic necrosis (IPN) and 14 patients progressed to organ failure (OF), the occurrence of which were the study outcomes. The patients were divided into pairs groups: IPN and non‑IPN, as well as OF and non‑OF, and differences between the groups were determined regarding various clinicopathological parameters. Furthermore, univariate and multivariate regression analyses were performed to identify parameters associated with the risk of progression to IPN or OP. On univariate analysis, the following parameters were deemed as being significantly associated with the risk of IPN: Serum calcium ions, C‑reactive protein (CRP), extent of necrosis, procalcitonin (PTC) and the MCTSI. Furthermore, calcium ions, red cell distribution width (RDW), extent of necrosis and the MCTSI were significantly associated with the risk of OF on univariate analysis. Multivariate logistic regression analysis for these parameters then indicated that CRP (P=0.014), RDW (P=0.025) and the extent of necrosis (P=0.022) were significant and independent predictors of progression; thus, these are early risk factors for patients with HLAP. Receiver operating characteristic curves were generated to evaluate the predictive value of these factors, and the area under the curve for the three parameters was 0.863 [95% confidence interval (CI), 0.646‑0.886], 0.727 (95% CI, 0.651‑0.803) and 0.833 (95% CI, 0.739‑0.936), respectively. Therefore, CRP, RDW and the extent of necrosis are early predictive indexes for the risk of progression in HLAP.

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1	Al Mofleh IA: Severe acute pancreatitis: Pathogenetic aspects and prognostic factors. World J Gastroenteml. 14:675–684. 2008. View Article : Google Scholar
2	Zerem E, Imamovic G, Omerović S and Imširović B: Randomized controlled trial on sterile fluid collections management in acute pancreatitis: Should they be removed? Surg Erldosc. 23:2770–2777. 2009. View Article : Google Scholar
3	Bollen TL: Imaging of acute pancreatitis: Update of the revised Atlanta classification. Radiol Clin North Am. 50:429–445. 2012. View Article : Google Scholar : PubMed/NCBI
4	Beger HG and Rau BM: Severe acute pancreatitis: Clinical course and management. World J Gastroenterol. 13:5043–5051. 2007. View Article : Google Scholar : PubMed/NCBI
5	Yadav D and Lowenfels AB: The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 144:1252–1261. 2013. View Article : Google Scholar : PubMed/NCBI
6	Rashid N, Sharma PP, Scott RD, Lin KJ and Toth PP: All-cause and acute pancreatitis health care costs in patients with severe hypertriglyceridemia. Pancreas. 46:57–63. 2017. View Article : Google Scholar : PubMed/NCBI
7	Qiu L, Sun RQ, Jia RR, Ma XY, Cheng L, Tang MC and Zhao Y: Comparison of existing clinical scoring systems in predicting severity and prognoses of hyperlipidemic acute pancreatitis in Chinese patients: A retrospective study. Medicine (Baltimore). 94:e9572015. View Article : Google Scholar : PubMed/NCBI
8	Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG and Vege SS: AcutePancreatitis Classification Working Group: Classification of acute pancreatitis-2012: Revision of the Atlanta classification and definitions by international consensus. Gut. 62:102–111. 2013. View Article : Google Scholar : PubMed/NCBI
9	Cameron JL, Crisler C, Margolis S, DeMeester TR and Zuidema GD: Acute pancreatitis with hyperlipemia. Surgery. 70:53–61. 1971.PubMed/NCBI
10	Fortson MR, Freedman SN and Webster PD III: Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 90:2134–2139. 1995.PubMed/NCBI
11	Yadav D and Pitchumoni CS: Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol. 36:54–62. 2003. View Article : Google Scholar : PubMed/NCBI
12	Rehan A, Shabbir Z, Shaukat A and Riaz O: Diagnostic accuracy of modified CT severity index in assessing severity of acute pancreatitis. J Coll Physicians Surg Pak. 26:967–970. 2016.PubMed/NCBI
13	Cao X, Cao F, Li A, Gao X, Wang XH, Liu DG, Fang Y, Guo DH and Li F: Predictive factors of pancreatic necrosectomy following percutaneous catheter drainage as a primary treatment of patients with infected necrotizing pancreatitis. Exp Ther Med. 14:4397–4404. 2017.PubMed/NCBI
14	Besselink M, Van-Santvoort HM, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CH, Schaapherder AF and Gooszen HG: Dutch Acute Pancreatitis Study Group: Timing and impact of infections in acute pancreatitis. Br J Surg. 96:267–273. 2009. View Article : Google Scholar : PubMed/NCBI
15	van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ali Ahmed U, Schrijver AM, Boermeester MA, van Goor H, Dejong CH, van Eijck CH, et al: A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 141:1254–1263. 2011. View Article : Google Scholar : PubMed/NCBI
16	Huang YX, Jia L, Jiang SM, Wang SB, Li MX and Yang BH: Incidence and clinical features of hyperlipidemic acute pancreatitis from Guangdong, China: A retrospective multicenter study. Pancreas. 43:548–552. 2014. View Article : Google Scholar : PubMed/NCBI
17	Chang YT, Chang MC, Tung CC, Wei SC and Wong JM: Distinctive roles of unsaturated and saturated fatty acids in hyperlipidemic pancreatitis. World J Gastroenterol. 21:9534–9543. 2015. View Article : Google Scholar : PubMed/NCBI
18	Nair S, Yadav D and Pitchumoni CS: Association of diabetic ketoacidosis and acute pancreatitis: Observations in 100 consecutive episodes of DKA. Am J Gastroenterol. 95:2795–2800. 2000. View Article : Google Scholar : PubMed/NCBI
19	Morita Y, Yoshikawa T, Takeda S, Matsuyama K, Takahashi S, Yoshida N, Clemens MG and Kondo M: Involvement of lipid peroxidation in free fatty acid-induced isolated rat pancreatic acinar cell injury. Pancreas. 17:383–389. 1999. View Article : Google Scholar
20	Saharia P, Margolis S, Zuidema GD and Cameron JL: Acute pancreatitis with hyperlipemia: Studies with an isolated perfused canine pancreas. Surgery. 82:60–67. 1977.PubMed/NCBI
21	Cardoso FS, Ricardo LB, Oliveira AM, Canena JM, Horta DV, Papoila AL and Deus JR: C-reactive protein prognostic accuracy in acute pancreatitis: Timing of measurement and cutoff points. Eur J Gastroenterol Hepatol. 25:784–789. 2013. View Article : Google Scholar : PubMed/NCBI
22	Khanna AK, Meher S, Prakash S, Tiwary SK, Singh U, Srivastava A and Dixit VK: Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg. 2013:3675812013. View Article : Google Scholar : PubMed/NCBI
23	Yin G, Hu G, Cang X, Yu G, Hu Y, Xing M, Chen C, Huang Y, Tang M, Zhao Y, et al: C-reactive protein: Rethinking its role in evaluating the severity of hyperlipidemic acute pancreatitis. Pancreas. 43:1323–1328. 2014. View Article : Google Scholar : PubMed/NCBI
24	Tsuang W, Navaneethan U, Ruiz L, Palascak JB and Gelrud A: Hypertriglyceridemic pancreatitis: Presentation and management. Am J Gastroenterol. 104:984–991. 2009. View Article : Google Scholar : PubMed/NCBI
25	Zhou CL, Zhang CH, Zhao XY, Chen SH, Liang HJ, Hu CL and Chen NW: Early prediction of persistent organ failure by serum apolipoprotein A-I and high-density lipoprotein cholesterol in patients with acute pancreatitis. Clin Chim Acta. 476:139–145. 2018. View Article : Google Scholar : PubMed/NCBI
26	Cui J, Xiong J, Zhang Y, Peng T, Huang M, Lin Y, Guo Y, Wu H and Wang C: Serum lactate dehydrogenase is predictive of persistent organ failure in acute pancreatitis. J Crit Care. 41:161–165. 2017. View Article : Google Scholar : PubMed/NCBI
27	Peng T, Peng X, Huang M, Cui J, Zhang Y, Wu H and Wang C: Serum calcium as an indicator of persistent organ failure in acute pancreatitis. Am J Emerg Med. 35:978–982. 2017. View Article : Google Scholar : PubMed/NCBI
28	Peng T, Zhang Y, Wu H and Wang C: Assessment of red blood cell distribution width as an early predictor of persistent organ failure in patients with acute pancreatitis. Pancreas. 18:393–398. 2017.
29	Wang D, Yang J, Zhang J, Zhang S, Wang B, Wang R and Liu M: Red cell distribution width predicts deaths in patients with acute pancreatitis. J Res Med Sci. 20:424–428. 2015. View Article : Google Scholar : PubMed/NCBI
30	Patel KV, Semba RD, Ferrucci L, Newman AB, Fried LP, Wallace RB, Bandinelli S, Phillips CS, Yu B, Connelly S, et al: Red cell distribution width and mortality in older adults: A meta-analysis. J Gerontol A Biol Sci Med Sci. 65:258–265. 2010. View Article : Google Scholar : PubMed/NCBI
31	Meyrignac O, Lagarde S, Bournet B, Mokrane FZ, Buscail L, Rousseau H and Otal P: Acute pancreatitis: Extrapancreatic necrosis volume as early predictor of severity. Radiology. 276:119–128. 2015. View Article : Google Scholar : PubMed/NCBI
32	Mentula P, Kylänpää ML, Kemppainen E, Jansson SE, Sarna S, Puolakkainen P, Haapiainen R and Repo H: Early prediction of organ failure by combined markers in patients with acute pancreatitis. Br J Surg. 92:68–75. 2010. View Article : Google Scholar