Triglyceride Threshold for Intensive Lipid-Lowering Therapy in Acute Hyper-Triglyceridemic Pancreatitis: A Retrospective Study

Background: The prognostic significance of early triglyceride (TG) reduction in hyper-triglyceridemic acute pancreatitis (HTG-AP) remains controversial. This study aimed to investigate the association between admission TG levels, early TG goal achievement, and clinical outcomes in patients with HTG-AP. Methods: This retrospective study included 345 patients with HTG-AP. Early TG goal achievement was defined as TG ≤ 5.65 mmol/L within 72 h of admission. Disease severity was classified according to the Revised Atlanta Classification. Associations between TG parameters and outcomes were analyzed using ordinal logistic regression. Results: No significant differences were observed between the goal-achieved (n = 274) and non-goal-achieved (n = 71) groups regarding pancreatic necrosis, hospital stay, or in-hospital mortality. Admission TG levels demonstrated that the highest TG levels did not correspond to the most severe disease course. Compared to patients with admission TG > 90.4 mmol/L, those with TG levels between 11.3 and 56.5 mmol/L had significantly lower odds of more severe disease, while no significant differences were found for TG levels between 56.5 and 90.4 mmol/L. Neither admission TG levels nor the degree of TG reduction within 72 h was significantly correlated with pancreatic necrosis. Conclusions: Early TG goal achievement was not associated with improved clinical outcomes in patients with HTG-AP. The routine use of aggressive early lipid-lowering therapy requires further validation before it can be routinely recommended. TG ≥ 56.5 mmol/L might represent a threshold for disease progression risk. Further studies are needed to determine the clinically meaningful cutoff value.