Wang Yuchen, Attar Bashar M, Abu Omar Yazan, Agrawal Rohit, Demetria Melchor V
Pancreas. 2019 Jan;48(1):126-130. doi: 10.1097/MPA.0000000000001192.
The relative rarity of hypertriglyceridemia (HTG) as the etiology for acute pancreatitis (AP) delays the final diagnosis of hypertriglyceridemia-induced AP (HTG-AP). This study aimed to explore the diagnostic and prognostic value of pseudohyponatremia in this clinical entity.
We retrospectively compared 140 patients with HTG-AP and 266 patients of AP of other etiologies. The correlation of presenting hyponatremia and a final diagnosis of HTG-AP is evaluated.
Presenting hyponatremia had an area under curve of 0.926 for predicting the diagnosis of HTG-AP. After dichotomization by the optimal cutoff value of 130 mEq/dL, patients with hyponatremia had a higher prevalence of acute kidney injury (61.9% vs 38.1%, P < 0.001), systemic inflammatory response syndrome (52.2% vs 47.8%, P < 0.001), a higher Ranson criteria (3.0 vs 1.4, P < 0.001), and a higher Bedside Index for Severity of Acute Pancreatitis score (0.69 vs 0.55, P = 0.011).
Presenting hyponatremia is highly efficient in differentiating hypertriglyceridemia from other etiologies of AP. It also demonstrated promising prognostic values in both AP and HTG-AP patients. Therefore, initial serum sodium could potentially provide the first clue of HTG-AP, as well as facilitate risk-stratifying patients to determine treatment allocation.
高甘油三酯血症（HTG）作为急性胰腺炎（AP）病因相对罕见，这延迟了高甘油三酯血症性急性胰腺炎（HTG-AP）的最终诊断。本研究旨在探讨假性低钠血症在该临床实体中的诊断和预后价值。
我们回顾性比较了140例HTG-AP患者和266例其他病因的AP患者。评估了出现的低钠血症与HTG-AP最终诊断之间的相关性。
出现的低钠血症预测HTG-AP诊断的曲线下面积为0.926。以130 mEq/dL的最佳截断值进行二分法后，低钠血症患者急性肾损伤的患病率更高（61.9%对38.1%，P<0.001），全身炎症反应综合征的患病率更高（52.2%对47.8%，P<0.001），兰森标准更高（3.0对1.4，P<0.001），急性胰腺炎严重程度床边指数评分更高（0.69对0.55，P=0.011）。
出现的低钠血症在区分HTG与其他AP病因方面效率很高。它在AP和HTG-AP患者中也显示出有前景的预后价值。因此，初始血清钠可能为HTG-AP提供首个线索，并有助于对患者进行风险分层以确定治疗分配。
