Low-grade inflammation for predicting severe acute pancreatitis in patients with hypertriglyceridemic acute pancreatitis

Abstract

Objectives: We aimed to evaluate the association between low-grade inflammation (LGI) and the severity of hypertriglyceridemic acute pancreatitis (HTG-AP).

Methods: We retrospectively reviewed 311 patients with HTG-AP who were admitted to the Department of Gastroenterology, Fujian Provincial Hospital between April 2012 and March 2021. Inpatient medical and radiological records were reviewed to collect the clinical manifestations, disease severity, and comorbidities. C-reactive protein (CRP) level, white blood cell (WBC) count, platelet (PLT) count, and neutrophil-to-lymphocyte ratio (NLR) were considered LGI components and were combined to calculate a standardized LGI score. The association between the LGI score and the severity of HTG-AP was analyzed using univariate and multivariate logistic regression analyses.

Results: Of the 311 patients with HTG-AP, 47 (15.1%) had mild acute pancreatitis (MAP), 184 (59.2%) had moderately severe acute pancreatitis (MSAP), and 80 (25.7%) had severe acute pancreatitis (SAP), respectively. Patients with MSAP and SAP had a higher LGI score than those with MAP (1.50 vs -6.00,P < 0.001). Univariate logistic regression analysis revealed that patients with LGI scores in the fourth quartile were more likely to have MSAP and SAP (odds ratio [OR] 21.925, 95% confidence interval [CI] 5.014–95.867,P < 0.001). The multivariate logistic regression analysis confirmed that low calcium (OR 0.105, 95% CI 0.011–0.969,P = 0.047) and high LGI score (OR 1.253, 95% CI 1.066–1.473,P = 0.006) were associated with MSAP and SAP. When predicting the severity of acute pancreatitis, the LGI score had the highest area under the receiver operating characteristic (ROC) curve (0.7737) compared to its individual components.

Conclusion: An elevated LGI score was associated with a higher risk of SAP in patients with HTG-AP.

Keywords

hypertriglyceridemic acute pancreatitis / low-grade inflammation / severity

References

[1] YadavD,Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013; 144(6):1252-1261.

[2] ForsmarkCE,VegeSS, WilcoxCM. Acute pancreatitis. N Engl J Med. 2016; 375(20):1972-1981.

[3] ZhangN,ZhangHY, GuoXH,Liu LX. Changes of etiology in acute pancreatitis in recent 10 years in China: meta-analysis. Chin J Digest Med Imageology (Electronic Edn). 2016: 6(2):71-75.

[4] NawazH,Koutroumpakis E,EaslerJ, et al. Elevated serum triglycerides are independently associated with persistent organ failure in acute pancreatitis. Am J Gastroenterol. 2015; 110(10):1497-1503.

[5] NeoptolemosJP,RaratyM, FinchM,Sutton R. Acute pancreatitis: the substantial human and financial costs. Gut. 1998; 42(6):886-891.

[6] BarbareskoJ,KochM, SchulzeMB,Nöthlings U. Dietary pattern analysis and biomarkers of low-grade inflammation: a systematic literature review. Nutr Rev. 2013; 71(8):511-527.

[7] GalmésS,CifreM, PalouA,Oliver P,SerraF. A genetic score of predisposition to low-grade inflammation associated with obesity may contribute to discern population at risk for metabolic syndrome. Nutrients. 2019; 11(2):298.

[8] CandoreG,CarusoC, JirilloE,Magrone T,VastoS. Low grade inflammation as a common pathogenetic denominator in age-related diseases: novel drug targets for anti-ageing strategies and successful ageing achievement. Curr Pharm Des. 2010; 16(6):584-596.

[9] BonaccioM,Di Castelnuovo A,PounisG, et al; Moli-sani Study Investigators. A score of low-grade inflammation and risk of mortality: prospective findings from the Moli-sani study. Haematologica. 2016; 101(11):1434-1441.

[10] DaneshJ,WhincupP, WalkerM, et al. Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. BMJ. 2000; 321(7255):199-204.

[11] BhatT,TeliS, RijalJ, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 2013; 11(1):55-59.

[12] BonaccioM,Di Castelnuovo A,RagoL, et al; MOLI-SANI study investigators. T-wave axis deviation is associated with biomarkers of low-grade inflammation. Findings from the MOLI-SANI study. Thromb Haemost. 2015; 114(6):1199-1206.

[13] CaoX,WangHM, DuH, et al. Early predictors of hyperlipidemic acute pancreatitis. Exp Ther Med. 2018; 16(5):4232-4238.

[14] AbaylıB,Gençdal G,Değirmencioğlu Ş. Correlation between neutrophil/lymphocyte ratio and Ranson score in acute pancreatitis. J Clin Lab Anal. 2018; 32(6):e22437.

[15] YuSS,WuD, JinK, et al. Low serum ionized calcium, elevated high-sensitivity C-reactive protein, neutrophil-lymphocyte ratio, and body mass index (BMI) are risk factors for severe acute pancreatitis in patients with hypertriglyceridemia pancreatitis. Med Sci Monit. 2019; 25:6097-6103.

[16] ChenLF,HuangYB, YuHJ, et al. The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis. Lipids Health Dis. 2021; 20(1):9.

[17] PascualI,Sanahuja A,GarcíaN, et al. Association of elevated serum triglyceride levels with a more severe course of acute pancreatitis: cohort analysis of 1457 patients. Pancreatology. 2019; 19(5):623-629.

[18] HansenSEJ,MadsenCM, VarboA,Nordestgaard BG. Low-grade inflammation in the association between mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis: a study of more than 115000 individuals from the general population. Clin Chem. 2019; 65(2):321-332.

[19] BanksPA,BollenTL, DervenisC, et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62(1):102-111.

[20] Expert Group of the Expert consensus on emergency diagnosis and treatment of hypertriglyceridemic acute pancreatitis. Expert consensus on emergency diagnosis and treatment of hypertriglyceridemic acute pancreatitis. Chin General Pract. 2021; 24(30):3781-3793. [in Chinese].

[21] PrasadS,SungB, AggarwalBB. Age-associated chronic diseases require age-old medicine: role of chronic inflammation. Prev Med. 2012; 54(Suppl): S29-S37.

[22] EngströmG,HedbladB, StavenowL, et al. Incidence of obesity-associated cardiovascular disease is related to inflammation-sensitive plasma proteins: a population-based cohort study. Arterioscler Thromb Vasc Biol. 2004; 24(18):1498-1502.

[23] DaneshJ,WheelerJG, HirschfieldGM, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004; 350(14):1387-1397.

[24] RienstraM,SunJX, MagnaniJW, et al. White blood cell count and risk of incident atrial fibrillation (from the Framingham Heart Study). Am J Cardiol. 2012; 109(4):533-537.

[25] MinW,XiaohaoZ, JingjingC, et al. A score of low-grade inflammation for predicting stroke recurrence in patients with ischemic stroke. J Inflamm Res. 2021; 14:4605-4614.

[26] BonaccioM,Di Castelnuovo A,De CurtisA, et al; Moli-sani Project Investigators. Adherence to the Mediterranean diet is associated with lower platelet and leukocyte counts: results from the Moli-sani study. Blood. 2014; 123(19):3037-3044.

[27] Bosques-PadillaFJ,Vázquez-Elizondo G,González-Santiago O, et al. Hypertriglyceridemia-induced pancreatitis and risk of persistent systemic inflammatory response syndrome. Am J Med Sci. 2015; 349(3):206-211.

[28] Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013; 13(4 Suppl 2): e1-e15.

[29] TennerS,BaillieJ, DewittJ,Vege SS. American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013; 108(9):1400-1415.

[30] OlesenSS,HarakowA, KroghK,Drewes AM,HandbergA,ChristensenPA. Hypertriglyceridemia is often under recognized as an aetiologic risk factor for acute pancreatitis: a population-based cohort study. Pancreatology. 2021; 21(2):334-341.

[31] LiM,XingXK, LuZH, et al. Comparison of scoring systems in predicting severity and prognosis of hypertriglyceridemia-induced acute pancreatitis. Dig Dis Sci. 2020; 65(4):1206-1211.

[32] DiMY,LiuH, YangZY,Bonis PA,TangJL,LauJ. Prediction models of mortality in acute pancreatitis in adults: a systematic review. Ann Intern Med. 2016; 165(7):482-490.

[33] ParkSH,GooJM, JoCH. Receiver operating characteristic (ROC) curve: practical review for radiologists. Korean J Radiol. 2004; 5(1):11-18.

[34] OngY,ShelatVG. Ranson score to stratify severity in acute pancreatitis remains valid – old is gold. Expert Rev Gastroenterol Hepatol. 2021; 15(8):865-877.

[35] MikóA,VighÉ,MátraiP, et al. Computed tomography severity index vs. other indices in the prediction of severity and mortality in acute pancreatitis: a predictive accuracy meta-analysis. Front Physiol. 2019; 10:1002.

[36] GaoW, YangHX, MaCE.The value of BISAP score for predicting mortality and severity in acute pancreatitis: a systematic review and meta-analysis. PLoS One. 2015; 10(6):e0130412.

RIGHTS & PERMISSIONS

2023 The Authors. Journal of Digestive Diseases published by Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.