Global burden and characterization of hypertriglyceridemia-induced acute pancreatitis: results from a systematic review and a multi-center cohort study

To compare and characterize hypertriglyceridemia-induced acute pancreatitis (HTG-AP) across the geographical regions, we conducted a systematic review and a multi-center cohort study. We conducted a systematic review and random effects meta-analysis of studies reporting HTG-AP. Also, we separately characterized HTG-AP in a multi-center retrospective cohort study involving eight centers in China. The key outcomes of interest included the pooled proportion of HTG-AP and its severity parameters after adjusting for the effect of confounding factors through logistic regression. Our systematic review identified 110 studies from 15 countries accounting for 3,057,428 participants (35% female, median age 50 years). The pooled proportion of HTG-AP was 11.6% globally while the Eastern and Western countries reported the proportions as 16.3% and 5.4%, respectively (P<0.01). The pooled mortality rate was remarkably higher in Eastern countries (4.1%) than in Western countries (1.0%) (P<0.01). 3,224 participants (37% female, median age 48 years) were included in our multi-center cohort study, and the proportion of HTG-AP was much higher at 35.9% with a nearly three-fold higher mortality rate compared with acute pancreatitis (AP) due to other etiologies (odds ratio (OR): 2.77, 95% confidence interval (CI): 1.60 to 4.81). The proportion of patients with HTG-AP is remarkably higher in Eastern countries, particularly China, than in Western countries. Furthermore, compared with other causes of AP, HTG-AP has a poorer prognosis and may warrant aggressive management.