Key result
Rapid triglyceride lowering fails to improve organ failure-free days in hypertriglyceridemic acute pancreatitis.
Why the study?
No specific triglyceride-lowering therapy is recommended in patients with hypertriglyceridemia-associated acute pancreatitis due to lack of quality evidence.
Does rapid triglyceride lowering to ≤ 5.65 mmol/L improve organ failure-free days in patients with hypertriglyceridemia-associated acute pancreatitis?
Cohort (n=300)
Yes
Does rapid triglyceride lowering to ≤ 5.65 mmol/L improve organ failure-free days in patients with hypertriglyceridemia-associated acute pancreatitis?
More rapid triglyceride decline to ≤ 5.65 mmol/L within 3 days was not associated with improved incidence and duration of organ failure in patients with hypertriglyceridemia-associated acute pancreatitis.
Rapid triglyceride reduction was not associated with fewer organ failure days in hypertriglyceridemia-associated pancreatitis; leaves open optimal targets pending randomized trials.
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.
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Zhou et al. (2024) conducted a cohort in Hypertriglyceridemia-associated acute pancreatitis (n=300). Target reaching (plasma triglyceride ≤ 5.65 mmol/L on day 3) vs. Not reaching target (plasma triglyceride > 5.65 mmol/L on day 3) was evaluated on Organ failure-free days (OFFD) to 14 days of enrolment (Median difference 0, 95% CI 0-0, p=0.46). Reaching a plasma triglyceride target of ≤ 5.65 mmol/L on day 3 did not significantly improve organ failure-free days compared to not reaching the target in patients with hypertriglyceridemia-associated acute pancreatitis.
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