Association of hypertriglyceridemic waist phenotype with the severity and prognosis of acute pancreatitis

Objective To investigate the association of hypertriglyceridemic waist( HTGW) phenotype with the severity and prognosis of acute pancreatitis( AP). Methods A total of 356 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019 were enrolled as subjects and were divided into normal-waist-normal-triglyceride( NWNT)group,normal-waist-elevated-triglyceride( NWET) group,enlarged-waist-normal-triglyceride( EWNT) group,and HTGW group.The four groups were compared in terms of the clinical features including age sex,laboratory markers,disease grade,and complications. A one-way ANOVA was used for comparison of normally distributed continuous data between groups,and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and between any two groups. The chi-square test was used for comparison of dichotomous variables between multiple groups and between any two groups; the Kruskal-Wallis H test was used for comparison of ordered polytomous variables between multiple groups,and the Mann-Whitney U rank sum test was used for comparison between two groups. Univariate and multivariate logistic regression analyses were performed to investigate the influencing factors for organ failure and pancreatic infection and necrosis.Results The HTGW group had a significantly higher neutrophil count than the NWNT group,a significantly higher C-reactive protein level than the NWNT group and the NWET group,a significantly higher creatinine level than the NWNT group,significantly higher levels of total cholesterol,triglyceride,and low-density lipoprotein than the NWNT group and the EWNT group,a significantly lower level of high-density lipoprotein than the NWNT group and the EWNT group,and a significantly higher level of blood glucose than the NWNT group( all P <0. 05). The HTGW group had a significantly higher incidence rate of severe AP( SAP) than the other three groups( χ2= 189. 519,P <0. 001),as well as significantly higher incidence rates of infectious pancreatic necrosis and organ failure than the other three groups( χ2=11. 770 and 19. 457,P = 0. 008 and P < 0. 001). The univariate logistic regression analysis showed that sex,recurrence history were the risk factors for infectious pancreatic necrosis,and after the adjustment for these risk factors,the risk of infectious pancreatic necrosis in the HTGW group was 3. 347 times that in the NWNT group( 95% confidence interval [CI]: 1. 538-7. 283,P = 0. 002; body mass index,WTI,smoking,diabetes mellitus,and HTGW were the risk factors for organ failure( P < 0. 05),and after the adjustment for these risk factors,the risk of organ failure in the HTGW group was 4. 143 times that in the NWNT group( 95% CI: 1. 299-13. 219,P = 0. 016).Conclusion HTGW is an independent risk factor for the development of SAP and may affect patients' disease severity and complications.Such patients should be identified and diagnosed as early as possible,and improvement of dyslipidemia should be performed to improve patients' conditions and prognosis.