A Three-year Review of the Management of Hypertriglyceridaemia-induced Pancreatitis

Abstract

Background: Hypertriglyceridaemia is an oft-forgotten cause of acute pancreatitis, which can lead to delayed appropriate therapy and increased morbidity. Uncontrolled diabetes and acute alcohol ingestion can exacerbate this. There are no definite guidelines on management, and there is limited evidence supporting current treatment methods. Objective: A two-centre retrospective audit was conducted of acute pancreatitis presentations over three-years, and management reviewed of those with elevated triglyceride levels (≥6mmol/L). Results: Of 1628 presentations of pancreatitis between 01- Jan-2016 to 31-Dec-2018 to either Gold Coast University Hospital or Robina Hospital, 27 presentations (1.64%) from 20 patients are attributed to hypertriglyceridaemia on admission (mean 67.4mmol/L). 92.6% required admission into hospital (mean 11.5day). 36% had insulin infusion, 12% had apheresis, and 28% required intensive care admission. Only 84% were discharged on statins and/or fibrates. 72% of patients had further episodes hypertriglyceridaemia-induced pancreatitis. Pre-existing diabetes affected 44%, and HbA1c was measured in only 63.6% of these. Acute alcohol intake was relevant for 22.2% of presentations. Endocrinologist opinion was sought in 51.8%. Conclusion: Whilst hypertriglyceridaemia-induced pancreatitis is uncommon, it is undertreated and specialist opinion under-utilised. This increases risk of recurrence, morbidity, and further hospital presentations.