SESSION TITLE: Hot Topics in Critical Care
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 25, 2015 at 04:30 PM - 05:30 PM
PURPOSE: Hypertriglyceridemia (HTG) is the 3rd leading cause of acute pancreatitis (AP). The optimal therapy for HTG-induced AP (HTG-AP) is unknown. We studied our experience to identify optimal therapy for HTG-AP.
METHODS: We performed a retrospective 14-year chart review of patients treated for HTG-AP at Mayo Clinic (MN). AP and its severity was defined by the revised Atlanta classification. HTG was defined as TG >1000 mg/dL. Organ failure (OF) was calculated using the Marshall score.
RESULTS: 54 patients with 61 episodes of HTG-AP were identified. The majority (36; 67%) were males. Median age at diagnosis was 41 (IQR 34-48) years. Median lipase level was 740 (IQR 296-1895) U/L and median TG level was 3120 (IQR 1523-4927) mg/dL. Co-existing DM was noted in 45 (74%; 41 type 2 and 4 type 1) episodes, while concurrent DKA was seen in 18 (30%) episodes. History of gallstones was present in 4 (7%), while recent alcohol use was found in 5 (8%) episodes. The median Marshall score was 0 (IQR 0-1), and ≥1 OF was seen in 9 (15%) episodes at presentation. Mild AP was seen in 39 (63%), moderate AP in 14 (23%) and severe AP in 8 (13%) patients. All patients received usual care (NPO, fluids and analgesia) and some episodes received adjunct therapy with insulin infusion (41; 67%) and/or plasma exchange (PLEX) (5; 8%). Usual care alone was used in 19 (31%) episodes. Patients receiving PLEX had similar median TG levels compared to the others (3570 vs 2954, p=0.9). ICU stay occurred in 33 (54%) episodes. Median hospital and ICU lengths-of-stay (LOS) were 5 (IQR 3-8) and 3 (IQR 2-6.5) days, respectively. There was no in-hospital mortality. When we compared patients with severe AP versus those with mild or moderate AP, no differences were noted in median age (p=0.1), gender (p=0.7), lipase (p=0.2), TG (p=0.16), use of insulin infusion (p=1.0), PLEX (p=0.12) or usual care alone (p=1.0). However, patients with severe AP had significantly longer median hospital (19 vs 4, p<0.0001) and ICU (9 vs 2, p=0.007) LOS. Hospital and ICU LOS were similar between adjunct therapies, but median hospital LOS was lower with usual care alone (4 vs 6 days, p=0.06).
CONCLUSIONS: A large proportion (74%) of HTG-AP episodes are associated with DM and substantial proportions have DKA (30%). In-hospital mortality was not seen.
CLINICAL IMPLICATIONS: In HTG-AP, usual care is generally sufficient for patients, with addition of insulin infusion for severe hyperglycemia or DKA. The role of PLEX remains unclear given similar outcomes with or without its use.
DISCLOSURE: The following authors have nothing to disclose: Prashant Jagtap, Sumedh Hoskote, Santhi Vege, Vinaya Simha, Vivek Iyer
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