Measurement of apolipoprotein B levels helps in the identification of patients at risk for hypertriglyceridemic pancreatitis

BACKGROUND: Severe hypertriglyceridemia (HTG) is a common cause of acute pancreatitis, although even moderate HTG may elevate this risk. Identifying patients who are prone to hypertriglyceridemic pancreatitis (HTGP) can facilitate early, preventative interventions. OBJECTIVE: To examine advanced lipoprotein profile (ALP) of hypertriglyceridemic patients with and without HTGP to identify lipid and lipoprotein parameters which may help improve risk stratification. METHODS: This was a retrospective cohort study of adult patients with serum triglycerides (TGs) $ 500 mg/dL who underwent ALP testing. Chart reviews were conducted to identify those who developed HTGP or not. Comparisons of lipid profiles of patients with and without HTGP were performed using chi-square or rank-sum tests. ROC curves were generated to identify lipid and lipoprotein parameters which helped improve prediction of HTGP beyond serum TG levels. RESULTS: Fifty-eight subjects were included in the analysis. Twenty had at least one documented episode of HTGP. Among patients with HTGP, median serum TG concentrations were 2832 mg/dL vs. 978 mg/dL in the non-pancreatitis group (p < 0.001). Chylomicron TG/total TG, chylomicron TG/ VLDL TG, chylomicron TG/apoB, total TG/total Cholesterol, and total TG/apoB were significantly higher among the pancreatitis group. Total serum TG/apoB had the best discriminant value for predicting HTGP with an AUC-ROC of 0.87 (p < 0.001). A cutoff of .10.6 was associated with a sensitivity of 90% and specificity of 75%. CONCLUSION: Measurement of serum apoB levels and calculation of serum TG/apoB ratio may help identify hypertriglyceridemic patients at risk for HTGP. ? 2020 National Lipid Association. All rights reserved.

Automated summary

This study aimed to examine advanced lipoprotein profiles of hypertriglyceridemic patients with HTGP, in order to identify lipid and lipoprotein parameters that may help improve risk stratification. The results suggest that measuring serum apoB levels and calculating serum TG/apoB ratio could aid in identifying hypertriglyceridemic patients at risk for HTGP.