Do Elevated Triglycerides Truly Trigger Acute Pancreatitis?

Excerpt

Hypertriglyceridemia, the third most common cause of acute pancreatitis (AP) in the USA, has recently been reported to be the most common cause of AP in China [1]. There is an increased risk of severe acute pancreatitis in patients with hypertriglyceridemic AP, with a recent prospective study using trend analysis across patients with normal (< 150 mg/dL) to severe (≥ 1000 mg/dL) TG levels reporting significantly higher rates of persistent organ failure, need for ICU care, and longer length of hospital stay with rising triglyceride levels [2]. While a TG level of ≥ 1000 mg/dL is considered the threshold at which the risk of AP increases, the absolute risk is still low at 5%, which modestly increases to 10–20% in patients with TG levels > 2000 mg/dL [3]. Nonetheless, the risk of AP is not negligible at lower TG levels; a large epidemiologic study from Denmark reported increased risk of AP starting when TG levels were > 177 mg/dL (HR 2.3; 95% CI 1.3–4.0) that linearly increased to a HR 7.7; 95% CI 3–19.8 when TG levels were > 443 mg/dL [4, 5]. …