346 Improving the Detection of Hypertriglyceridemia-Induced Pancreatitis Through Reflex Triglyceride Testing: A Retrospective Cohort Study

Abstract Aim Hypertriglyceridemia is a well-recognised but often underdiagnosed cause of acute pancreatitis (AP). This study aimed to identify the true incidence of high triglyceride pancreatitis (HTGP) and assess the impact of introducing reflex triglyceride (TG) testing on diagnostic rates and timing. Method We conducted a retrospective observational cohort study of all AP cases between April 2022 and April 2024 across two District General Hospitals. Data were analysed for AP aetiologies, diagnostic methods and timing and frequency of TG testing. A reflex TG test, triggered by serum amylase >80 U/L was introduced in April 2023 at a cost of £1.42 per test. Outcomes pre and post reflex implementation were compared. Results Among 750 AP patients, HTGP (TG >5 mmol/L) accounted for 23 (3.05%) cases (10 cases pre-reflex, 13 post-reflex). Other causes included gallstones (43.20%), idiopathic (29.33%), alcohol-related (17.33%), and post-ERCP (4.27%). Pre-reflex, 41.4% idiopathic cases had lipid profiles evaluated, with only 32.6% within 24 hours. Post-reflex, this improved to 82.7% and 76.4%, respectively. Mean time from diagnosis to TG testing fell from 59.6 to 5.83 hours. Conclusions This study highlights that the true incidence of HTGP may be lower than currently reported in the literature. Given that HTGP is associated with increased morbidity and mortality compared to other aetiologies of pancreatitis, accurate and timely diagnosis is crucial. The introduction of reflex TG testing markedly improved efficiency, rate and timeliness of lipid profiling, and its routine use could be a cost-effective strategy for enhancing the early and accurate diagnosis of HTGP.