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

Abstract

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.

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

“…Patients treated with apheresis often had higher APACHE scores and TG levels. Systematic reviews of non-RCT, observational data found TPE did not decrease mortality, was not superior to conventional therapy, and resulted in a greater economic burden (Yan, 2022;Lin, 2022a). A two-center study comparing standard therapy (without insulin or heparin) versus TPE, observed TPE was used in patients with higher APACHE II scores, Bedside Index for Severity in Acute Pancreatitis (BISAP) scores, and TG levels.…”

Acute pancreatitis due to hypertriglyceridemia

“…This may be due to selection bias considering that all the included studies were nonrandomized controlled trials, in which the clinicians decided on the choice of treatment, and reasonably, plasmapheresis would be the option for the more severe patients. [ 30 ] Similarly, in our study, the decision of plasmapheresis was decided by the clinician according to the severity of the patient's clinic. This is why complications and mortality are higher.…”

Hypertriglyceridemia-induced Acute Pancreatitis in Diabetic Population

“…A systematic review and meta-analysis revealed that 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. 20,21 More comparative, prospective randomized highquality studies are still needed in the treatment of hypertriglyceridemia induced acute pancreatitis.…”