P1472 - Severe Acute Pancreatitis is Associated with Elevated Admission Serum Unbound Fatty Acids, Consistent with Their Deleterious Roles and a Hypoalbuminemic State

Prasad Rajalingamgari, MBBS, Mahmoud Morsy, MBBCh, Shubham Trivedi, BS, Hally Chaffin, MD, Sarah Jahangir, MBBS, Yu-Hui Chang, PhD, Christine Snozek, PhD, Vijay Singh, MD
Mayo Clinic Arizona, Scottsdale, AZ

Introduction: Several studies show association of hypoalbuminemia (PMID: 34921151) to severity in acute pancreatitis (AP). Hypoalbuminemia is also used for determining AP severity (PMID: 6510766). However, the underlying mechanisms are unclear. Albumin unbound fatty acids (uFAs) are generated from excessive fat necrosis during AP. Recent studies show that uFAs are stable monomers in the circulation (PMID: 33514548) and can cause organ failure (PMID: 35502320) and can injure immune cells resulting in sterile to septic transition of AP (PMID: 37263302). We therefore compared uFAs and albumin in severe and non-severe acute pancreatitis.

Methods: Patients presenting to the Emergency Room with serum lipase > 3-fold upper limit of normal between August 2019 and September 2022 were included. Excluded were patients lacking admission serum samples. Patients with organ failure for >48 hours were determined to be severe AP (SAP) and the remaining patients were determined to be non-severe AP (non-SAP). Demographics, BMI, lipase levels, admission uFAs and albumin were then compared between SAP and non-SAP patients. Continuous variables such as age, BMI, lipase levels, uFAs and albumin were compared using Mann-Whitney test. Categorical variables such as sex, race were compared using a Chi-square test. p-value less than 0.05 was considered significant.

Results: Among 316 patients, 25 patients had SAP and 291 patients had non-SAP. Patients with SAP had increased length of stay (days) (17 ±22 vs 4 ± 3; p: < 0.001) and were older (63 ± 14 vs 55 ± 17; p: 0.019) compared to non-SAP patients. There was no difference in sex distribution (females 32% vs 45%; p:0.208), BMI (kg/m2) (29 ± 6 vs 28 ± 6; p:0.375), race or lipase levels (U/L) (1535 ± 1085 vs 1269 ± 1035; p:0.233) between SAP and non-SAP patients respectively. SAP patients had significantly lower admission serum albumin (gm/dL) (3.87 ± 0.78 vs 4.32 ± 0.71; p: 0.02) levels when compared to non-SAP patients. Patients with SAP also had significantly elevated uFAs (µM) (4.81 ± 3.45) on admission compared to non-SAP patients (3.04 ± 2.19; p: 0.003).

Discussion: SAP patients had hypoalbuminemia and higher levels of unbound fatty acids on admission. These elevated uFAs are consistent with the concurrent acute hypoalbuminemia and previous studies showing that uFAs cause organ failure, thus hypothetically converting mild AP to severe AP.


Disclosures:


Prasad Rajalingamgari, MBBS, Mahmoud Morsy, MBBCh, Shubham Trivedi, BS, Hally Chaffin, MD, Sarah Jahangir, MBBS, Yu-Hui Chang, PhD, Christine Snozek, PhD, Vijay Singh, MD. P1472 - Severe Acute Pancreatitis is Associated with Elevated Admission Serum Unbound Fatty Acids, Consistent with Their Deleterious Roles and a Hypoalbuminemic State, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.