S103 Adverse Outcomes in Hypertriglyceridemia-Associated Acute Pancreatitis: A Propensity-Matched Cohort Analysis

Introduction: Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is the third leading cause of acute pancreatitis, following gallstones and alcohol. With the growing burden of obesity, diabetes, and metabolic syndrome, HTG-AP is becoming more common. When triglyceride levels rise above 1000 mg/dL, toxic fatty acids released in the bloodstream can trigger severe pancreatic inflammation and systemic complications. Despite this, there is limited real-world data comparing outcomes between HTG-AP and other types of acute pancreatitis. Methods: We used TriNetX, a global network of electronic health records, to identify adults with acute pancreatitis and either triglyceride levels ≥1000 mg/dL (HTG-AP) or <500 mg/dL (non-HTG-AP). Patients were matched 1:1 based on age, sex, BMI, and comorbidities, yielding 2 cohorts of 10,034 patients each. The primary outcome was 30-day mortality. Secondary outcomes included respiratory failure, acute kidney injury, pancreatic pseudocyst formation, drainage procedures, and ED/hospital visits within 6 months. Results: HTG-AP patients were younger but experienced significantly worse outcomes. Compared to non-HTG-AP, they had higher 30-day mortality (2.2% vs 1.5%; OR 1.49, P < 0.001), more respiratory failure (1.4% vs 1.0%; OR 1.41, P = 0.013), and greater healthcare utilization (49.0% vs 45.3%; OR 1.16, P < 0.001). Rates of acute kidney injury (2.0% vs 1.8%) and drainage procedures (0.3% in both) were comparable. Interestingly, pseudocyst formation was slightly more frequent in the non-HTG group (2.7% vs 2.2%; OR 0.80, P = 0.01). Conclusion: HTG-AP is associated with increased risk of mortality and complications despite affecting the younger population. Its pathophysiological profile, centered on toxic lipid metabolites, likely underlies these worse outcomes. Early recognition and aggressive triglyceride-lowering strategies are essential to reduce morbidity and mortality in this high-risk group.