Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2017; 23(47): 8387-8394
Published online Dec 21, 2017. doi: 10.3748/wjg.v23.i47.8387
Impact of cigarette smoking on recurrence of hyperlipidemic acute pancreatitis
Jun-Xi Xiang, Liang-Shuo Hu, Peng Liu, Bo-Yan Tian, Qing Su, Yi-Chun Ji, Xu-Feng Zhang, Xue-Min Liu, Zheng Wu, Yi Lv
Jun-Xi Xiang, Liang-Shuo Hu, Bo-Yan Tian, Qing Su, Yi-Chun Ji, Xu-Feng Zhang, Xue-Min Liu, Zheng Wu, Yi Lv, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Jun-Xi Xiang, Liang-Shuo Hu, Peng Liu, Xu-Feng Zhang, Xue-Min Liu, Yi Lv, Regenerative Medicine and Surgery Engineering Research Center of Shaanxi Province, Xi’an 710061, Shaanxi Province, China
Author contributions: Xiang JX analyzed the data and drafted the manuscript; Hu LS provided analytical oversight; Liu P and Tian BY offered the technical support; Su Q and Ji YC collected the data; Zhang XF and Liu XM revised the manuscript for important intellectual content; Wu Z provided administrative support; Lv Y designed and supervised the study; all authors have read and approved the final version to be published.
Supported by the National Natural Science Foundation of China, No. 81501608.
Institutional review board statement: The entire study was carried out in strict accordance with protocols approved by the Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University (Permit Number: 2017-017).
Informed consent statement: This study received an informed consent waiver from our Institutional Review Board due to minimal risk to study subjects.
Conflict-of-interest statement: The authors have declared that no conflicts of interest exist.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yi Lv, MD, PhD, Professor, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, No. 277, West Yanta Road, Xi’an 710061, Shaanxi Province, China. luyi169@126.com
Telephone: +86-29-85323902 Fax: +86-29-85323904
Received: October 18, 2017
Peer-review started: October 18, 2017
First decision: November 8, 2017
Revised: November 11, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: December 21, 2017
Processing time: 62 Days and 23.9 Hours
ARTICLE HIGHLIGHTS
Research background

Hyperlipidemic acute pancreatitis (HLAP) is a form of AP occurring in the presence of severe hypertriglyceridemia and in the absence of other causes. The exact pathophysiology of HLAP is not entirely certain. It is believed that HLAP is related to pancreatic tissue injury and microcirculation disturbance caused by free fatty acids. Some recent studies identified that smoking was significantly associated with non-biliary AP instead of biliary AP, but whether cigarette smoking has any long-term impact on HLAP recurrence has not yet been investigated. This is the first study evaluating the influence of cigarette smoking on HLAP recurrence.

Research motivation

Authors performed this study to better understand the relationship between cigarette smoking and HLAP recurrence, as well as the pathophysiologic mechanism of recurrent HLAP.

Research objectives

The main objective of this study was to investigate the impact of cigarette smoking on the recurrence rate and recurrence-free survival in HLAP. The authors found that cigarette smoking was associated with worse RFS and an increased recurrence rate of HLAP. These findings provide references for further clarifying the mechanism of HLAP.

Research methods

A total of 88 patients diagnosed with HLAP were enrolled in this retrospective study. Demographic data, medical history, previous episodes of pancreatitis, consumption of alcohol and cigarettes, as well as biochemical and hematological data were carefully recorded for univariate and multivariate analyses. During follow-up, the information on current smoking status and recurrent AP was gathered. Recurrence-free survival was calculated using the Kaplan-Meier method, and the differences between groups were compared using the log-rank test.

Research results

Current smokers had a remarkably higher recurrence rate and a greater incidence of repeated episodes of AP than non-smokers, and these two percentages were reduced to 9.1% and 36.4% for patients who gave up smoking. The median follow-up time was 13.5 mo. Multivariate analysis identified current smoking as an independent risk factor contributing to HLAP recurrence. Current smokers had significantly worse RFS than non-smokers, but no significant difference was documented between ex-smokers and non-smokers.

Research conclusions

In the present study, the authors found that cigarette smoking was associated with worse RFS and an increased recurrence rate of HLAP. For smokers, continued smoking might be strongly correlated with HLAP recurrence and compromised survival. Smoking cessation for at least 6 mo would lead to a significant advantage in recurrence rate and RFS compared to current smokers.

Research perspectives

The study revealed that smoking is associated with worse RFS and higher recurrence rate of HLAP. Besides, smoking cessation for at least 6 mo would lead to a significant advantage in recurrence rate and RFS compared to current smokers. For the future research, more detailed classification is needed to clarify the potential dose- and duration-dependent correlation between cigarette smoking and HLAP. Besides, expanding the number of cases and long-term follow-up are needed.