Dramatic Improvement in Severe Triglyceride-Induced Acute Pancreatitis after One Treatment with Plasmapheresis: A Case Report

Atluri, Sreedevi; Ollaywi, Manhal; Raju, Felix; Arjomand, Farhad; Anand, Sury

doi:10.14309/00000434-201310001-00873

Cited by 1 publication

(2 citation statements)

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“…Plasmapheresis was first described by Betteridge et al in 1978 for management of HTG-AP, and since then was reported in numerous cases reports/series as an effective treatment method [16][17][18][19][20][21]28]. In their systematic review, Click et al reviewed 301 unique patients with HTG-AP who underwent plasmapheresis from 74 case reports/series, and concluded that plasmapheresis is highly effective in reducing serum triglyceride levels and improving symptoms [29].…”

Section: Discussionmentioning

confidence: 99%

“…Adjunctive treatment with subcutaneous or intravenous (IV) insulin, and heparin might be beneficial through reducing the TG level, although no guidelines endorse these treatments [12][13][14][15]. Plasmapheresis rapidly removes serum TGs, and has often been reported in previous literature as an effective treatment method [16][17][18][19][20][21]. However, due to the heterogeneity in reported severity of AP and clinical outcomes used to determine efficacy, and lack of well-balanced control and treatment groups, the role of plasmapheresis in HTG-AP remains unclear [6,22].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the Effects of Plasmapheresis on Patients with Hypertriglyceridemia-induced Acute Pancreatitis

Wang¹,

Attar²,

Trick³

et al. 2018

Pancreat Disord Ther

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Objectives: Plasmapheresis has been repetitively reported as an effective treatment in hypertriglyceridemiainduced acute pancreatitis (HTG-AP). However, due to heterogeneity in presenting severity, different definition of clinical end-points and lack of well-matched control group, a definitive role of plasmapheresis is yet to be determined. Methods: We reviewed a cohort of 142 unique patients of HTG-AP, in which 15 cases were treated with plasmapheresis. We compared the epidemiologic characteristics, presenting clinical severity and various clinical end-points between plasmapheresis group and non-plasmapheresis group directly and after successful propensity score match. The clinical trajectory of plasmapheresis group and post-match nonplasmapheresis group were plotted and compared. Results: Patients who underwent plasmapheresis had higher triglyceride levels on admission, and had a trend toward more severe pancreatitis. The unmatched cohort revealed that plasmapheresis group had longer hospital stay, required more intravenous insulin, and had longer duration of nil per os. However post-match comparison revealed that plasmapheresis had no effect on clinical outcomes. Despite the successful match of epidemiologic characteristics and presenting clinical severity, plasmapheresis group was responding slower than post-match nonplasmapheresis group, which suggests the existence of unmeasured confounding factors and possibility of obscured benefit given the similarities in various end-points. Conclusions: Although plasmapheresis had no apparent benefit or harm, there likely was residual confounding based on the different clinical trajectories between the plasmapheresis and non-plasmapheresis groups. Randomized controlled trial, or a larger multicentre observational study taking into consideration the clinical trajectory is needed to further evaluate the role of plasmapheresis in HTG-AP.

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