Relationship between low-density lipoprotein cholesterol and severe acute pancreatitis ("the lipid paradox")

Wandong Hong; Vincent Zimmer; Simon Stock; Maddalena Zippi; Jones Aq Omoshoro-Jones; Mengtao Zhou

doi:10.2147/TCRM.S159387

Relationship between low-density lipoprotein cholesterol and severe acute pancreatitis ("the lipid paradox")

Ther Clin Risk Manag. 2018 May 30:14:981-989. doi: 10.2147/TCRM.S159387. eCollection 2018.

Authors

Wandong Hong^#¹, Vincent Zimmer^#^{2

3}, Simon Stock^#⁴, Maddalena Zippi⁵, Jones Aq Omoshoro-Jones⁶, Mengtao Zhou⁷

Affiliations

¹ Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
² Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.
³ Department of Medicine, Marienhausklinik St Josef Kohlhof, Neunkirchen, Germany.
⁴ Department of Surgery, World Mate Emergency Hospital, Battambang, Cambodia.
⁵ Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy.
⁶ Department of Surgery, Chris Hani-Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
⁷ Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.

^# Contributed equally.

Abstract

Background and aim: The aim of this study was to investigate the association between low-density lipoprotein cholesterol (LDL-C) and the development of severe acute pancreatitis (SAP).

Patients and methods: A total of 674 patients with acute pancreatitis were enrolled. Non-linearity in the relationship between LDL-C and SAP was assessed by restricted cubic spline analysis. Univariable and multivariable regression analyses were used to identify independent risk factors of SAP.

Results: The restricted cubic spline analysis suggested a nonlinear association between high-density lipoprotein cholesterol (HDL-C), LDL-C and triglyceride levels and incidence of SAP. The incidence of SAP in patients with low LDL-C (<90 mg/dL), moderate LDL-C (90-150 mg/dL) and high LDL-C (>150 mg/dL) levels was 15.1%, 3.7% and 9.8%, respectively. Multivariable analysis confirmed that low LDL-C levels (odds ratio [OR] 3.05; 95% confidence interval [CI] 1.35-6.90), high LDL-C levels (OR 4.42; 95% CI 1.41-13.87) and low HDL-C levels (OR 6.90; 95% CI 2.61-18.23) but not high triglyceride levels (OR 1.05; 95% CI 0.40-2.72) were associated with the development of SAP.

Conclusion: Both low LDL-C (<90 mg/dL) and high LDL-C (>150 mg/dL) levels within 24 hours from admission are independently associated with an increased risk of SAP.

Keywords: acute pancreatitis; high-density lipoprotein cholesterol; lipids; low-density lipoprotein cholesterol; risk factor; severe acute pancreatitis.