Health outcomes and survival among patients with severe hypertriglyceridemia after acute pancreatitis

BACKGROUND: Severe hypertriglyceridemia (sHTG) can lead to complications, the most serious being acute pancreatitis (AP). Risk of sHTG-induced AP increases with higher triglyceride (TG) levels, resulting in worse clinical outcomes compared to AP due to other etiologies. OBJECTIVE: Characterize health outcomes of patients with combined sHTG and AP (sHTG-AP) compared to patients with sHTG without AP. METHODS: Our retrospective cohort study estimated clinical outcomes and mortality of patients with sHTG-AP (triglycerides 500-15,000 mg/dL) compared to propensity score-matched patients with sHTG alone, using a nationally representative de-identified claims database with 2012-2022 enrollees. RESULTS: A total of 1232 patients with sHTG-AP and 96,207 patients with sHTG without AP were identified. After 1:1 propensity score matching (PSM), 1197 patients from each group were included. Mean (SD) follow-up was 2.9 (2.1) years for sHTG-AP and 3.0 (2.2) years for sHTG without AP (P = .310). Risks of emergency department (ED) visits (hazard ratio HR 1.6; 95% CI, 1.6 1.4-1.7; P < .001), hospitalizations (HR 1.7; 95% CI, 1.5-2.0; P < .001), and death (HR 1.8; 95% CI, 1.4-2.4; P < .001) were statistically significantly higher in patients with sHTG-AP; patients with index triglycerides ≥880 mg/dL were also at greater risk. PSM identified 330 patients without baseline type 2 diabetes (T2DM) in each group; probability of developing T2DM was nearly double in patients with sHTG-AP than sHTG without AP. CONCLUSION: ED visits, hospitalizations, and mortality were more common in patients with sHTG-AP than sHTG without AP, warranting better prevention of initial episodes. Prospective studies are also needed to establish causal links between AP and clinical outcomes.