The Effect of Different Lipid-Lowering Methods on the Clinical Outcomes of Hypertriglyceridemic Acute Pancreatitis

BACKGROUND: Current management strategies for Hypertriglyceridemic acute pancreatitis (HTGP) predominantly rely on lipid-lowering agents and sequential insulin-mediated triglyceride reduction. However, the comparative efficacy of these interventions remains incompletely elucidated. METHODS: A retrospective cohort study was conducted on 193 HTGP patients admitted to Nanfang Hospital, Southern Medical University, from January 1, 2018, to September 30, 2023. Patients were stratified into 2 arms: one receiving lipid-lowering drug and the other undergoing sequential insulin therapy for lipid reduction. Propensity score matching (PSM) was used to mitigate baseline confounding variables, facilitating a comparative analysis of the clinical outcomes between the 2 groups. Furthermore, univariate and multivariate logistic regression models were utilized to ascertain predictors of ICU admission in the HTGP cohort. RESULTS: Irrespective of PSM status, the sequential insulin group demonstrated a statistically significant earlier initiation of open diet time ( P <0.05) compared with the lipid-lowering drug group, albeit with a concurrent significant increase in the incidence of hypoglycemic ( P <0.05). Post-PSM analysis revealed superior cost-effectiveness in the sequential insulin group ( P =0.019). APACHE II score and CRP emerged as independent risk factors for ICU admission, whereas HDL conferred independent protection( P <0.05 for all). CONCLUSIONS: Sequential insulin therapy for HTGP offers advantages over lipid-lowering drugs in terms of earlier open diet time and reduced hospitalization costs. Nevertheless, the heightened risk of hypoglycemia necessitates vigilant monitoring for this potential adverse event.