S192 Elevated Serum Lipase Worsens Outcomes of Acute Diseases

Introduction: High blood lipase levels are commonly associated with acute pancreatitis. However, 20-30% of patients with lipase 3 times the upper limit of normal may not have pancreatitis. Here, we investigate the consequences of elevated lipase causing fat breakdown, thus generating non-esterified fatty acids (NEFAs) that overwhelm the albumin's binding capacity. The resulting levels of albumin unbound fatty acids (uFAs) were compared between patients with different severities. Methods: Patients presenting to Mayo Clinic Arizona's Emergency Department with lipase levels >3 times upper limit of normal between August 2019 and April 2023 were included. Those with pancreatitis, cancer and hemodialysis were excluded. Organ failure, ICU admission, and 1-year mortality were the study endpoints. Admission serum triglycerides (TGs), total NEFA, NEFA/Albumin ratio and uFAs were compared between patients with and without these endpoints. Results: One hundred-two patients met the inclusion criteria. Twenty among these developed organ failure, 15 had acute kidney injury, 2 required supplemental oxygen, 1 had heart failure, and 2 had multiple organ failure. Patients who developed organ failure had higher triglycerides (321 ± 317 vs 227 ± 170 mg/dL, P = 0.031), higher NEFA/albumin ratio (206 ± 97 vs 154 ± 131, P = 0.026), and uFAs (4.1 ± 2.1 vs 2.7 ± 2 uM, P = 0.004) compared to those without organ failure. The 11 patients requiring ICU admission had elevated TGs (323 ± 253 vs 236 ± 202 mg/dL, P = 0.046), elevated NEFA/albumin ratio (226 ± 82 vs 157 ± 129, P = 0.021), and elevated uFAs (4.7 ± 1.4 vs 2.8 ± 2.1 µM, P < 0.001) vs non-ICU patients. The 8 patients who died within a year had higher uFA levels (4.6 ± 1.4 vs 2.9 ± 2.1 µM, P = 0.006) than survivors. The area under the receiver operating characteristic curve (ROC AUC) of uFAs was 0.79 (95% CI 0.67–0.91, P = 0.007) for predicting 1-year mortality. This was independent of and comparable to the Charlson Comorbidity Index (AUC = 0.73, 95% CI 0.51–0.94, P = 0.036), which is used to predict mortality. Conclusion: Patients with hyperlipasemia demonstrating excessive TG breakdown and elevated unbound fatty acids at admission had greater risks of organ failure, ICU admission and 1-year mortality. The elevated risk was comparable to the Charlson Comorbidity Index. Therefore, unbound fatty acids have significant prognostic value and targeting excessive fat breakdown in these patients could potentially improve clinical outcomes.