Association of HDL-C and ApoA-I with persistent organ failure in hypertriglyceridemia-associated acute pancreatitis: insights from a multicenter registry

Serum triglycerides have been believed to play a key role in the pathophysiology of hypertriglyceridemia-associated acute pancreatitis (HTG-AP). However, mechanistic studies have shown that high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (ApoA-I) may also be involved. We aimed to investigate whether admission levels of HDL-C and ApoA-I were associated with adverse outcomes in HTG-AP. Participants enrolled in the national PERFORM registry between November 2020 and November 2023, with available HDL-C and ApoA-I levels at enrollment, were retrospectively analyzed. The primary outcome was persistent organ failure (POF) within 14 days. Multivariable logistic regression models were used to examine the association of tertiles of HDL-C and ApoA-I with POF risk. Cochran–Armitage trend test and restricted cubic splines were performed to explore the dose–response relationship. Among the 325 patients eventually included, 52 (16.0%) developed POF. Within each low-to-high tertile of ApoA-I, the rate of POF decreased proportionally ( p < 0.001 by Cochran–Armitage trend test). After controlling for selected confounders, the highest tertile of ApoA-I was significantly associated with reduced risk of POF when compared with the lowest tertile (adjusted OR = 0.16, 95% CI 0.05–0.56, p = 0.004). Furthermore, spline analyses demonstrated a decrease in the risk of POF with increasing ApoA-I levels ( p for overall = 0.021). However, no significant association between HDL-C levels and POF was identified, regardless of regression and trend analyses. ApoA-I, but not HDL-C, was inversely associated with the risk of developing POF in HTG-AP patients. Trial registration : The PERFORM study was registered in the Chinese Clinical Trial Registry (ChiCTR2000039541), on October 30, 2020.