Background The treatment of acute pancreatitis (AP) induced by hypertriglyceridemia (HTG) remains controversial with regard to plasmapheresis vs conventional treatment. We reviewed relevant articles to explore the efficacy of plasmapheresis in the management of HTG‐induced AP. Methods We systematically reviewed studies that compared plasmapheresis with conventional treatment for HTG‐induced AP using three databases: PubMed, Embase, and Cochrane Library, as well as relevant references. The primary outcomes were 24 h triglyceride reduction rate and in‐hospital mortality. Results A total of 791 articles were retrieved. Finally, 15 observational studies (1080 participants) were included, most of which were historical cohort studies. Compared with conventional treatment, plasmapheresis assisted in the reduction of serum triglyceride (TG) levels in the first 24 h after hospital admission (standardized mean difference [SMD]: 0.58; 95% confidence interval [CI]: 0.17 to 0.99; P = 0.005). However, it resulted in increased hospitalization costs (thousand yuan) (weighted mean difference [WMD]: 24.32; 95% CI: 12.96 to 35.68; P < 0.001). With regard to in‐hospital mortality, although the mortality rate in the plasmapheresis group was higher than that in the conventional treatment group (relative risk [RR]: 1.74; 95% CI: 1.03 to 2.94; P = 0.038), the result was disturbed by confounding factors as per the subgroup and sensitivity analysis, as well as trial sequential analysis (TSA). No significant differences were found in other outcomes, including systematic complications, local complications, the requirement for surgery, and hospitalization duration. Conclusion The effect of plasmapheresis in HTG‐induced AP is not superior to that of conventional treatment, even resulting in a greater economic burden to patients and health care system. High quality randomized control trials are required to obtain a more a definitive understanding of this issue.

Background and Aims Arteriovenous fistula (AVF) dysfunction is a common complication in patients undergoing maintenance hemodialysis (MHD). Elevated serum level of fibroblast growth factor 21 (FGF21) was associated with atherosclerosis and cardiovascular mortality. However, its association with vascular access outcomes remains elusive. In this study, we aimed to evaluate the relationship of serum FGF21 levels with AVF dysfunction and all-cause mortality in patients undergoing MHD. Method We performed a study of patients undergoing MHD who received AVF creation at a tertiary medical center in China from January 2018 to December 2019. Serum FGF21 concentration was detected by enzyme-linked immunosorbent assay (ELISA). Patients were followed-up to record two clinical outcomes, including AVF functional patency loss and all-cause mortality. The follow-up period ended at April 30, 2022. Kaplan-Meier curves were used to analyze AVF dysfunction events and mortality. Univariate and multivariate Cox proportional risk model analyses were used to calculate risk ratios (HR) and 95% CI and independent prognostic factors. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to analyze the predictive value of FGF21 in AVF functional patency loss and all-cause mortality. Results Among 147 patients, the mean age was 58.49±14.41 years, and 58.50% of them were males. The median serum level of FGF21 was 150.15 (70.57-318.01) pg/ml. During median follow-up period of 40.83 months, the serum level of FGF21 was an independent predictor for AVF functional patency loss (per 1 pg/mL increase, HR 1.002 [95% CI: 1.001-1.003, P = 0.003]. Besides, patients with higher serum level of FGF21 was more likely to suffer from all-cause mortality (per 1 pg/mL increase, HR 1.002 [95% CI: 1.000-1.003, P = 0.014]. The optimal cutoffs for FGF21 to predict AVF functional patency loss and all-cause mortality in patients undergoing MHD were 149.98 pg/ml and 146.43 pg/ml, with an AUC of 0.701 (95% CI 0.606-0.796, P = 0.001) and 0.677 (95% CI 0.566-0.788, P = 0.006), respectively. Conclusion Serum FGF21 level was an independent risk factor and predictor for AVF functional patency loss and all-cause mortality in patients undergoing MHD.