Acute Pancreatitis in Patients With Severe Hypertriglyceridemia in a Multi-Ethnic Minority Population

Ambika Amblee, MD; Divyanshu Mohananey, MD; Micheal Morkos, MD; Sanjib Basu, PhD; Ayokunle T. Abegunde, MD; Malini Ganesh, MD; Neil Bhalerao, MD; Amrutha Mary George, MD; Milli Jain, MD; Leon Fogelfeld MD

Disclosures

Endocr Pract. 2018;24(5):429-436. 

In This Article

Methods

Patients

In this retrospective study, patients found to have severe HTG in Cook County Health & Hospitals System, an urban safety-net hospital system in Chicago, Illinois, catering to a diverse racial community, were analyzed. The patient population of this system is approximately 53% African American and 29% Hispanic. Inclusion criteria for this study were adult patients (≥18 years) who were found to have a fasting TG ≥1,000 mg/dL whether in inpatient or outpatient settings at any point of time during the collection period from 2003 to 2013. Exclusion criteria included age <18 years or TG <1,000 mg/dL. A diagnosis of HTG-AP was made when any two of the following three criteria were present: abdominal pain characteristic of pancreatitis, computed tomography (CT) evidence of pancreatitis, or serum lipase levels three times the upper level of normal[15] and documented TG >1,000 mg/dL at time of presentation. In cases where multiple episodes of pancreatitis occurred in the same patient, the first episode of AP was included in the analysis.

Based on detailed chart review, spanning from January 2003 to March 2013, we obtained demographic data including self-identified race or ethnicity, presenting symptoms, and presence of risk factors such as excessive alcohol intake, family history of pancreatitis, smoking, recent trauma, preceding endoscopic retrograde cholagiopancreatography (ERCP), infections, and human immunodeficiency virus (HIV) status. Gallstone disease was considered present if documented in admission history or in previous or current imaging investigations (ultrasound or CT). Excessive alcohol intake was defined using the Centers for Disease Control definition stating that it includes binge and heavy drinking.[16]

Laboratory values collected included TG levels, lipase levels, calcium, parathyroid hormone levels, hemoglobin A1c (HbA1c), thyroid-stimulating hormone (TSH), and free tetraiodothyronine (FT4). Our lab utilized the Olympus Beckman® assay for lipase, TGs, and calcium. The Access Immunoassay System® was used for TSH and FT4.

Statistical Analysis

Descriptive statistics are reported as percentages for binary and categorical variables as mean and standard deviation if normally distributed and as median (interquartile range) if nonnormally distributed for variables measured on a continuous scale. The significance of association between categorical variables was measured by the χ 2 test. Variables measured on continuous scale were compared between two groups by the independent-samples t test, or alternatively, by the nonparametric Mann-Whitney test.

Univariate analysis was used to test the association of age, race, excessive alcohol use, gallstone disease, smoking, TG levels, and diabetes mellitus (DM) with AP (Table 1). We included all risk factors with P<.10 in the univariate model into our multivariable risk-adjusted model (Table 2).

Receiver operating characteristic (ROC) curves were used to describe the best predictors for AP development. Based on multivariable analysis, a predictive model for HTG-AP was developed[17] based on variables which were significantly associated with AP. We used 3-fold cross-validation for internal validation of our model in which the patients were divided into three groups of equal sizes; two of the groups were used as training sets based on which probability of AP development was predicted for the remaining validation group. This process was repeated three times. These cross-validated predictions were plotted against the actual data of AP occurrence in a cross-validated ROC curve. A 2-tailed P<.05 was considered statistically significant. SPSS version 24 software (IBM Corp) was used for all statistical analyses. The study was approved by the Institutional Review Board of Cook County Health & Hospitals System.

processing....