Clinical analysis of the therapeutic effect of plasma exchange on hypertriglyceridemic acute pancreatitis: A retrospective study

Abstract

Background The therapeutic effect of plasma exchange (PE) on hypertriglyceridemic acute pancreatitis (HTGAP) is unclear. Therefore, we aimed to explore this therapeutic effect. Study design and methods This study included 204 patients with HTGAP who underwent treatment at two provincial tertiary grade A hospitals in Fujian Province from October 2012 to May 2021. Patients were divided into a conventional group and a PE group. The Student's t‐test and chi‐square test were used for data analysis. Results Among 204 patients, 56 and 148 were included in the PE and conventional groups, respectively. After propensity score matching (PSM), the PE and conventional groups each had 42 patients. There was no significant difference in age; sex; pregnancy; comorbidities; laboratory findings; incidences of complications, and multiple organ dysfunction syndrome (MODS); organ support treatment; surgical rate; mortality; and hospital stay between the groups (p > 0.05). The total expenses were significantly higher in the PE group than in the conventional group (p < 0.05). There was no statistically significant difference in the times of PE; total volume of PE; incidences of complications, and MODS; organ support treatment; surgical rate; mortality; and hospital stay between the early PE and delayed PE groups (p > 0.05). All patients in the PE group and conventional group with acute renal failure had significantly higher D‐dimer levels than those without acute renal failure (p < 0.05). Discussion Compared with conventional treatment, PE does not have a better therapeutic effect on HTGAP. The D‐dimer level can predict whether patients with HTGAP will have acute renal failure.

Plasmapheresis compared with conventional treatment for hypertriglyceridemia‐induced acute pancreatitis: A systematic review and meta‐analysis

“…The main characteristics of the studies are listed in Table 1 14,20‐33 . The included studies were published between 2004 and 2022, and most were historical cohort studies.…”

“…The main characteristics of the studies are listed in Table 1. 14,[20][21][22][23][24][25][26][27][28][29][30][31][32][33] The included studies were published between 2004 and 2022, and most were historical cohort studies. Our search showed no published RCTs on this topic.…”

“…Pregnant women were included either completely or partially in four studies. 21,22,30,33 In addition, four studies included DFPP as a treatment group. 20,24,25,32…”

Apheresis Illustrated. Hyper‐triglyceridemic acute pancreatitis: A milky situation

“…Chylomicrons are then hydrolyzed into free fatty acids, which are toxic to the endothelium and acinar cells, 2 further exacerbating tissue damage within pancreas. While early initiation of TPE can rapidly lower TG levels and is often used in the setting of HTGAP, 2 recent studies fail to show benefits of TPE over conventional medical management 3 . TPE for HTGAP is an ASFA Category III indication, 4 thus treatment decision making should be individualized 4 …”

“…While early initiation of TPE can rapidly lower TG levels and is often used in the setting of HTGAP, 2 recent studies fail to show benefits of TPE over conventional medical management. 3 TPE for HTGAP is an ASFA Category III indication, 4 thus treatment decision making should be individualized. 4 Lipemia can cause significant interference in laboratory testing, leading to erroneous results.…”