• Jing Zhou, Zuozheng Wang, Qinghong Liu, Longxiang Cao, Enrique de-Madaria, Gabriele Capurso, Christian Stoppe, Dong Wu, Wei Huang, Yingjie Chen, Siyao Liu, Donghuang Hong, Yun Sun, Zhenguo Zeng, Kaixiu Qin, Haibin Ni, Yi Sun, Yue Long, Feng Guo, Xiaofeng Liu, Xisheng Zheng, Guoxiu Zhang, Xiangcheng Zhang, Kai Zhou, Yizhe Chen, Qinghai Jiao, Xinsen Zou, Xiang Luo, Gang Li, Bo Ye, Chao Li, Lanting Wang, Shuai Li, John Windsor, Yuxiu Liu, Zhihui Tong, Weiqin Li, Lu Ke, and Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG).
• Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
• Bmc Med. 2024 Nov 15; 22 (1): 535535.

BackgroundNo specific triglyceride-lowering therapy is recommended in patients with hypertriglyceridemia-associated acute pancreatitis (HTG-AP), primarily because of the lack of quality evidence. This study aimed to describe practice variations in triglyceride-lowering therapies for early HTG-AP patients and assess whether more rapid triglyceride decline is associated with improving organ failure.MethodsThis is a multicentre, prospective cohort study recruiting HTG-AP patients with elevated plasma triglyceride (> 11.3 mmol/L) admitted within 72 h from the onset of symptoms. Patients were dichotomised on study day 3 into either target reaching (plasma triglyceride ≤ 5.65 mmol/L) or not. The primary outcome was organ failure-free days (OFFD) to 14 days of enrolment. The association between target-reaching and OFFD was modelled. Additionally, the slope in plasma triglyceride over the first three days in response to treatment was calculated, and its association with OFFD was assessed as a sensitivity analysis.ResultsAmong the 300 enrolled patients, 211 underwent exclusive medical treatment, and 89 underwent various blood purification therapies. Triglyceride levels were available in 230 patients on study day 3, among whom 122 (53.0%) had triglyceride levels of ≤ 5.65 mmol/l. The OFFD was not different between these patients and those in whom plasma triglyceride remained > 5.65 mmol/L [median (IQR): 13 (10-14) vs. 14 (10-14), p = 0.46], even after adjustment for potential confounders. For the decline slopes, there was no significant change in OFFD with a steeper decline slope [risk difference, - 0.088, 95% CI, - 0.334 to 0.158, p = 0.48].ConclusionsTriglyceride-lowering therapies vary greatly across centres. More rapid triglyceride decline was not associated with improving incidence and duration of organ failure.© 2024. The Author(s).

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