ORIGINAL ARTICLE
Hypertriglyceridemia is a Risk Factor for Acute Kidney Injury in the Early Phase of Acute Pancreatitis Congye Wu, MD, Lu Ke, MD, Zhihui Tong, MD, Baiqiang Li, MD, Lei Zou, MD, Weiqin Li, MD, Ning Li, MD, and Jieshou Li, MD
Objective: The aim of this study was to investigate the risk factors for acute kidney injury (AKI) in patients with acute pancreatitis (AP). Methods: Patients with AP were retrospectively divided into AKI group and non-AKI group. To investigate the risk factors for AKI, logistic regression analysis was performed with demography, etiologies, and comorbidities. Mortalities of patients with different body mass indexes were compared. Results: There were 43 patients with AKI and 202 patients without AKI. The risk factor for AKI in AP was hypertriglyceridemia (odds ratio, 2.964; 95% confidence interval, 1.485Y5.915; P = 0.007). Forty-two patients developed AKI within the first 48 hours. The mortalities of normal weight, overweight, and obese groups in patients with AKI were 16.7%, 17.4%, and 62.5%, respectively. All the 4 patients who died in the non-AKI group were of normal weight. Conclusions: Hypertriglyceridemia is an independent risk factor for AKI in the early phase of AP. Obesity does not increase mortality of patients without AKI. We hypothesize that the role of pancreatic enzymes on triglyceride accumulated in renal may be an explanation for AKI in the early phase of AP. Key Words: obesity, hypertriglyceridemia, acute kidney injury, acute pancreatitis, risk factor (Pancreas 2014;43: 1312Y1316)
A
cute kidney injury (AKI) is an early complication of acute pancreatitis (AP) relating with high morbidity and mortality.1 The management of patients with AKI in AP is challenging. It is not very clear about the pathogenesis; most authors attribute it to cytokine cascades caused by systemic inflammatory response syndrome (SIRS) in the early phase of disease.2Y5 Retrospectively, clinical studies indicate that the history of renal disease, hypoxemia, and abdominal compartment syndrome are risk factors for AKI,6 and the severity factors include chronic diseases, local pancreatic complications, and presence of multiple organ failure and their number.7Y9 However, the initial order of AKI, acute respiratory disease syndrome (ARDS), and intra-abdominal hypertension is not fixed after AP onset. It is questionable to investigate the causal relationship between these complications. In general thought, cytokines play the trigger role in the pathophysiology course of AKI in AP10; it is easy to ignore the adverse effects of comorbidities and other physical conditions on renal function during the course of AP. As we know, AKI may emerge within a few hours after AP onset; it is reasonable From the Department of SICU, Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing, Jiangsu, China. Received for publication November 26, 2013; accepted April 10, 2014. Reprints: Weiqin Li, MD, Department of SICU, Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, P.R. China (e
Hypertriglyceridemia is a Risk Factor for Acute Kidney Injury in the Early Phase of Acute Pancreatitis Congye Wu, MD, Lu Ke, MD, Zhihui Tong, MD, Baiqiang Li, MD, Lei Zou, MD, Weiqin Li, MD, Ning Li, MD, and Jieshou Li, MD
Objective: The aim of this study was to investigate the risk factors for acute kidney injury (AKI) in patients with acute pancreatitis (AP). Methods: Patients with AP were retrospectively divided into AKI group and non-AKI group. To investigate the risk factors for AKI, logistic regression analysis was performed with demography, etiologies, and comorbidities. Mortalities of patients with different body mass indexes were compared. Results: There were 43 patients with AKI and 202 patients without AKI. The risk factor for AKI in AP was hypertriglyceridemia (odds ratio, 2.964; 95% confidence interval, 1.485Y5.915; P = 0.007). Forty-two patients developed AKI within the first 48 hours. The mortalities of normal weight, overweight, and obese groups in patients with AKI were 16.7%, 17.4%, and 62.5%, respectively. All the 4 patients who died in the non-AKI group were of normal weight. Conclusions: Hypertriglyceridemia is an independent risk factor for AKI in the early phase of AP. Obesity does not increase mortality of patients without AKI. We hypothesize that the role of pancreatic enzymes on triglyceride accumulated in renal may be an explanation for AKI in the early phase of AP. Key Words: obesity, hypertriglyceridemia, acute kidney injury, acute pancreatitis, risk factor (Pancreas 2014;43: 1312Y1316)
A
cute kidney injury (AKI) is an early complication of acute pancreatitis (AP) relating with high morbidity and mortality.1 The management of patients with AKI in AP is challenging. It is not very clear about the pathogenesis; most authors attribute it to cytokine cascades caused by systemic inflammatory response syndrome (SIRS) in the early phase of disease.2Y5 Retrospectively, clinical studies indicate that the history of renal disease, hypoxemia, and abdominal compartment syndrome are risk factors for AKI,6 and the severity factors include chronic diseases, local pancreatic complications, and presence of multiple organ failure and their number.7Y9 However, the initial order of AKI, acute respiratory disease syndrome (ARDS), and intra-abdominal hypertension is not fixed after AP onset. It is questionable to investigate the causal relationship between these complications. In general thought, cytokines play the trigger role in the pathophysiology course of AKI in AP10; it is easy to ignore the adverse effects of comorbidities and other physical conditions on renal function during the course of AP. As we know, AKI may emerge within a few hours after AP onset; it is reasonable From the Department of SICU, Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing, Jiangsu, China. Received for publication November 26, 2013; accepted April 10, 2014. Reprints: Weiqin Li, MD, Department of SICU, Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, P.R. China (e
