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. 2025 May 15;25(1):374.
doi: 10.1186/s12876-025-03954-4.

A systematic review of the epidemiology and risk factors for severity and recurrence of hypertriglyceridemia-induced acute pancreatitis

Jiongdi Lu #  1   2 , Zhe Wang #  1   2 , Wentong Mei  1   2 , Kaixin Peng  3   4 , Liang Zhang  5 , Gang Wang  5 , Kedong Xu  6 , Zheng Wang  6 , Yunpeng Peng  7 , Zipeng Lu  7 , Xiaolei Shi  8 , Guotao Lu  8 , Li Wen #  9   10 , Feng Cao #  11   12 ; Chinese Hypertriglyceridemia-Associated Pancreatitis Study Group (CHPSG)
Affiliations

A systematic review of the epidemiology and risk factors for severity and recurrence of hypertriglyceridemia-induced acute pancreatitis

Jiongdi Lu et al. BMC Gastroenterol. .

Abstract

This systematic review aims to comprehensively assess the epidemiology and identify risk factors associated with the severity and recurrence of hypertriglyceridemia-induced acute pancreatitis (HTG-AP). A search of PubMed, Web of Science, and Cochrane databases was conducted to identify all relevant randomized controlled trials (RCTs), prospective, or retrospective cohort studies on HTG-AP. Data related to epidemiology and risk factors for severity and recurrence of HTG-AP were extracted and analyzed. Seventy-seven studies met the inclusion criteria, comprising 1 RCT, 21 prospective studies, and 55 retrospective studies. A total of 56,617 acute pancreatitis (AP) patients were included, of which 19.99% were diagnosed with HTG-AP (n = 11,315). Compared to non-HTG-AP patients, HTG-AP patients were more likely to be male (68.7% vs. 57.3%) and younger (mean age 41.47 ± 4.32 vs. 50.25 ± 7.70 years). HTG-AP patients exhibited higher mortality rates (up to 20% vs. 15.2%), increased severity (8.3% to 100% vs. 3.8% to 47.2%), and higher recurrence rates (up to 64.8% vs. 23.3%). Analysis of temporal trends from 2002 to 2023 showed a range of HTG-AP prevalence in overall AP patients from 1.6% to 47.6%, with a slight upward trend that was not statistically significant (P = 0.1081). Regional analysis indicated relatively stable prevalence in North America (P = 0.5787), Europe (P = 0.0881), other regions (P = 0.738), while prevalence in China showed a significant increase (P = 0.0119). Thirteen studies investigated risk factors affecting HTG-AP severity, with elevated serum triglyceride (TG) levels associated with increased risk of complications such as pancreatic necrosis, systemic inflammatory response syndrome (SIRS), shock, and multi-organ failure. Additional factors including high neutrophil-to-lymphocyte ratio (NLR), elevated levels of amylase and C-reactive protein (CRP), hypocalcemia, and hypoalbuminemia were also implicated in HTG-AP severity. Smoking history, poor lipid control (TG > 3.1 mmol/L), or recurrent hypertriglyceridemia during follow-up were identified as potential predictors of HTG-AP recurrence. Our findings indicate a stable global prevalence of HTG-AP within AP patients, but a notable increase in China, possibly attributed to socio-economic and dietary factors.

Keywords: Hypertriglyceridemia-induced Acute pancreatitis; Incidence; Recurrence; Severity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All data used for the secondary analysis in our manuscript are from published, ethically reviewed studies that have ensured patient privacy protection and data anonymization. Therefore, ethical statements are not applicable in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Time trend of the proportion of HTG-AP patients
Fig. 3
Fig. 3
Regional trends in the proportion of HTG-AP patients
See this image and copyright information in PMC

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