Objective: To investigate the risk factors for patients with hypertriglyceridemia-related acute pancreatitis (HTG-AP) developing into severe acute pancreatitis or experiencing organ failure. Methods: This retrospective cohort study collected clinical data from 2 429 patients diagnosed with acute pancreatitis from five hospitals in China between January 2019 and December 2023 using a pre-designed data collection form. The cohort included 1 516 males and 913 females,with an age of (50.2±16.5)years(range: 11 to 99 years). Among them,353 patients (16.1%) had HTG-AP,while 1 846 (83.9%) had non-HTG-AP. HTG-AP was defined as serum triglyceride levels>500 mg/dl with other etiologies excluded. Intergroup comparisons were performed using t-tests,Mann-Whitney U test or χ² tests,respectively. Univariate and multivariate logistic regression analyses were conducted to assess risk factors for severe acute pancreatitis after adjusting for potential confounders,and a predictive model was developed and validated. Results: Compared with other etiologies,HTG-AP patients had a higher risk of progressing to SAP (OR=1.415,95%CI: 0.866 to 2.312, P=0.017) and organ failure (OR=1.256,95%CI: 1.015 to 1.554, P=0.036). Among HTG-AP patients,risk factors for SAP included body mass index (OR=1.856,95%CI: 1.742 to 1.987, P=0.033),fasting blood glucose (OR=1.128,95%CI: 1.036 to 1.229, P=0.006),white blood cell count(OR=1.162,95%CI: 1.055 to 1.281, P=0.002),and the presence of pleural effusion (OR=13.151,95%CI: 4.330 to 19.946, P<0.01). A nomogram prediction model for SAP in HTG-AP was constructed based on these risk factors,demonstrating good discriminative ability with area under the curve values of 0.877 in the training set and 0.894 in the validation set,along with satisfactory calibration. Conclusions: HTG-AP patients are at higher risk of developing SAP and organ failure. The risk prediction model incorporating body mass index,fasting blood glucose,white blood cell count,and pleural effusion shows good predictive value for SAP.
目的： 探讨高甘油三酯血症相关性急性胰腺炎（HTG-AP）患者发展为重症急性胰腺炎或出现器官功能衰竭的风险因素。 方法： 本研究为回顾性队列研究。使用预先设计的数据收集表，收集了2019年1月至2023年12月在我国5家医院诊断为重症急性胰腺炎的2 429例患者的临床数据。男性1 516例，女性913例；年龄（50.2±16.5）岁（范围：11~99岁）。其中HTG-AP患者353例（16.1%），非HTG-AP患者1 846例（83.9%）。HTG-AP 的定义为血清甘油三酯水平>500 mg/dl，并排除其他病因。组间比较采用独立样本t检验、Mann-Whitney U检验或χ2检验。通过单因素和多因素Logistic回归分析，调整潜在的混杂因素后，评估重症急性胰腺炎的风险因素，建立并验证预测模型。 结果： 与非HTG-AP患者相比，HTG-AP患者发展为重症急性胰腺炎（OR=1.415，95%CI：0.866~2.312，P=0.017）和出现器官功能衰竭（P=0.036，OR=1.256，95%CI：1.015~1.554）的风险更高。单因素和多因素Logistic回归分析结果显示，HTG-AP患者发展为重症急性胰腺炎的风险因素包括体重指数（OR=1.856，95%CI：1.742~1.987，P=0.033）、空腹血糖（OR=1.128，95%CI：1.036~1.229，P=0.006）、白细胞计数（OR=1.162；95%CI：1.055~1.281，P=0.002）及是否有胸腔积液（OR=13.151，95%CI：4.330~19.946，P<0.01）。结合以上风险因素构建HTG-AP发生重症急性胰腺炎的Nomogram预测模型，预测模型在训练集中的曲线下面积为0.877，在测试集中为0.894，具有较好的校准度。 结论： HTG-AP患者发展为重症急性胰腺炎和器官功能衰竭的风险较高。基于体重指数、空腹血糖、白细胞计数及是否有胸腔积液构建的重症急性胰腺炎的风险预测模型有较好的预测价值。.