The effect of serum triglyceride concentration on the outcome of acute pancreatitis: systematic review and meta-analysis

Abstract

Elevated serum triglyceride concentration (seTG, >1.7 mM or >150 mg/dL) or in other words hypertriglyceridemia (HTG) is common in the populations of developed countries. This condition is accompanied by an increased risk for various diseases, such as acute pancreatitis (AP). It has been proposed that HTG could also worsen the course of AP. Therefore, in this meta-analysis, we aimed to compare the effects of various seTGs on the severity, mortality, local and systemic complications of AP, and on intensive care unit admission. 16 eligible studies, including 11,965 patients were retrieved from PubMed and Embase. The results showed that HTG significantly elevated the odds ratio (OR = 1.72) for severe AP when compared to patients with normal seTG (<1.7 mM). Furthermore, a significantly higher occurrence of pancreatic necrosis, persistent organ failure and renal failure was observed in groups with HTG. The rates of complications and mortality for AP were significantly increased in patients with seTG >5.6 mM or >11.3 mM versus <5.6 mM or <11.3 mM, respectively. We conclude that the presence of HTG worsens the course and outcome of AP, but we found no significant difference in AP severity based on the extent of HTG.

Figure 1

Flow diagram for article selection.

Figure 2

The effects of seTG >1.7 and 1.7–11.3 mM vs. <1.7 mM on AP severity, mortality, pancreatic necrosis, pulmonary and renal failure, and persistent OF. (A) Forest plot shows the influence of seTG over 1.7 mM compared with normal seTG (<1.7 mM). (B) The outcomes for the 1.7–11.3 mM seTG group were compared with those in patients with normal seTG (<1.7 mM). Filled rhombuses represent the risk ratio derived from the studies analysed. Horizontal bars represent 95% CI. Empty rhombuses show the overall effect (OR is the middle of the rhombus and CIs are the edges). The quality of studies was assessed by the Newcastle-Ottawa Scale with the timing of the seTG measurement (for more details see Supplementary Table S2). Abbreviations: AP, acute pancreatitis; CI, confidence interval; Comp., comparability; NR, not relevant; meas., measurement; OF, organ failure; OR, odds ratio; seTG, serum triglyceride concentration.

Figure 3

The effects of serum triglyceride concentration (seTG) at 1.7–5.6 mM and >5.6 mM vs. <1.7 mM on acute pancreatitis (AP) severity. (A) Forest plot shows the influence of 1.7–5.6 mM seTG compared with normal seTG (<1.7 mM). (B) The outcome of the >5.56mM seTG group was compared with the outcomes of patients with normal seTG (<1.7 mM). Filled rhombuses represent the risk ratio derived from the manuscripts analysed. Horizontal bars represent 95% CI. Empty rhombuses show the overall effect, odds ratio (OR) is the middle of the rhombus, and confidence intervals (CI) are the edges. The quality of studies was assessed by the Newcastle-Ottawa Scale with the timing of the seTG measurement (for more details see Supplementary Table S2). Abbreviations: CI, confidence interval; Comp., comparability; NR, not relevant; meas., measurement; OR, odds ratio; seTG, serum triglyceride concentration.

Figure 4

Forest plot showing the effect of seTG >11.33 mM vs. <1.7 mM on AP severity, mortality, persistent OF and the need for ICU. Filled rhombuses represent the risk ratio derived from the articles analysed. Horizontal bars represent 95% CI. Empty rhombuses show the overall effect (OR is the middle of the rhombus and CIs are the edges). The quality of studies was assessed by the Newcastle-Ottawa Scale with the timing of the seTG measurement (for more details see Supplementary Table S2). Abbreviations: AP, acute pancreatitis; CI, confidence interval; comp., comparability; ICU, intensive care unit; NR, not relevant; meas., measurement; OR, odds ratio; seTG, serum triglyceride concentration.

Figure 5

The effects of seTG of 1.7–5.6, >5.6 and >11.3 mM vs. <1.7 mM on AP severity. The difference between ORs in seTG subgroups (1.7–5.6, >5.6 and >11.3 mM) were compared. The probability value for the difference in OR was 0.108 after the analysis.

Figure 6

Forest plot showing the effect of seTG >5.6 mM vs. <5.6 or 1.7–5.6 mM on AP severity, mortality, and pulmonary and renal failure. (A) Forest plot shows the influence of seTG over 5.6 mM compared with that of seTG <5.6 mM. (B) The AP severity in the > 5.6 mM seTG group was compared with that in patients with seTG in the 1.7–5.6 mM range. Filled rhombuses represent the risk ratio derived from the articles analysed. Horizontal bars represent 95% CI. Empty rhombuses show the overall effect (OR is the middle of the rhombus and CIs are the edges). The quality of studies was assessed by the Newcastle-Ottawa Scale with the timing of the seTG measurement (for more details see Supplementary Table S2). Abbreviations: AP, acute pancreatitis; CI, confidence interval; comp., comparability; NR, not relevant; meas., measurement; OR, odds ratio; seTG, serum triglyceride concentration.

Figure 7

Forest plot showing the effect of seTG >11.3 mM vs. <11.3 on AP severity, mortality, pancreatic necrosis, the need for ICU admission and multiple OF. Filled rhombuses represent the risk ratio derived from the articles analysed. Horizontal bars represent 95% CI. Empty rhombuses show the overall effect (OR is the middle of the rhombus and CIs are the edges). The quality of studies was assessed by the Newcastle-Ottawa Scale with the timing of the seTG measurement (for more details see Supplementary Table S2). Abbreviations: AP, acute pancreatitis; CI, confidence interval; comp., comparability; ICU, intensive care unit; NR, not relevant; meas., measurement; OF, organ failure; OR, odds ratio; seTG, serum triglyceride concentration.

Figure 8

Forest plot showing the effect of seTG >11.3 mM vs. 1.7–11.3 on AP severity, mortality and persistent OF. Filled rhombuses represent the risk ratio derived from the articles analysed. Horizontal bars represent 95% CI. Empty rhombuses show the overall effect (OR is the middle of the rhombus and CIs are the edges). The quality of studies was assessed by the Newcastle-Ottawa Scale with the timing of the seTG measurement (for more details see Supplementary Table S2). Abbreviations: AP, acute pancreatitis; CI, confidence interval; comp., comparability; NR, not relevant; meas., measurement; OF, organ failure; OR, odds ratio; seTG, serum triglyceride concentration.

Figure 9

Schematic diagram shows the effect of normal seTG and HTG on the severity and complications of AP. Abbreviations: HTG, hipertriglyceridemia; seTG, serum triglyceride concentration.