The role of double filtration plasmapheresis in hypertriglyceridemic pancreatitis: A propensity score matching analysis

Abstract

Introduction The role of double filtration plasmapheresis (DFPP) in hypertriglyceridemic pancreatitis (HTGP) is still not well established. Our study aimed to investigate the efficacy of DFPP in reducing triglyceride levels as well as their effects on the outcomes of HTGP. Material and methods We retrospectively evaluated the data of patients with HTGP presenting within 72 hours from symptom onset between January 2016 and February 2019. Patients with DFPP treatment were compared with those without DFPP treatment. We used a propensity score matching analysis to reduce confounding factors. Results Of the 249 patients enrolled, 88 (35.3%) were treated with DFPP. The DFPP was initiated at a median of 7.7 hours from the time of presentation. In the propensity score‐matched cohort (n = 100), patients with DFPP had a significantly lower level of triglyceride (P = .034), higher triglyceride reduction (P = .005), and the proportion of triglyceride <5.65 mmol/L (P = .002) by 24 hours after admission when compared with those without DFPP. However, this efficacy did not last until 48 hours after admission. No differences were found in terms of the majority of the clinical outcomes between the two groups, including persistent organ failure (P = .098), local complications (P = .213), hospital stay (P = .657), and in‐hospital mortality (P > .999). Conclusions HTGP patients with early initiation of DFPP were associated with rapidly and efficiently reduction of triglyceride levels compared with those without DFPP. However, DFPP showed no beneficial effects on improving the clinical outcomes of HTGP.

Comparable Triglyceride Reduction With Plasma Exchange and Insulin in Acute Pancreatitis – A Randomized Trial

“…Insulin activates lipoprotein lipase and was successfully used in patients with increased glucose levels ( 14 ) or even overt diabetic ketoacidosis, but also in patients without hyperglycemia ( 15 , 16 ). Reduction of triglycerides of about 44% ( 17 ) within the first day was reported in cohorts treated with insulin and 48–72% ( 9 , 13 ) in cohorts with conservative treatment, often including insulin. There is only one non-randomized comparison of insulin therapy with fasting-only, which did not show a more rapid fall in triglycerides ( 18 ).…”

“…The use of PE for removal of triglycerides was first described by Betteridge in 1978 ( 11 ). There are moderately sized cohorts published reporting approximately 80% reduction during the first PE or double filtration plasmapheresis (DFPF) treatment ( 12 , 13 ) and many case series reporting symptomatic relief. On the other hand, less invasive treatment with intravenous insulin and heparin was also described in smaller cohorts.…”

Double filtration plasmapheresis in hypertriglyceridemic pancreatitis: Triglyceride levels and clinical outcomes

“…The data that support the findings of this letter are openly available from the six reference articles 1‐6 …”

Potential differences between double‐filtration plasmapheresis and therapeutic plasma exchange in the treatment of acute hypertriglyceridemic pancreatitis

“…Although the importance of removal of these molecules has not been tested in clinical setting and the effectiveness of TPE itself in the treatment of hypertriglyceridemic pancreatitis remains to be established, there is an important theoretical difference between partially selective DFPF and non-selective TPE, which might be a reason for the non-effectiveness of DFPF, observed in the study. 1 Given this differences, it is intriguing that in the study, there were twice as many patients with persistent respiratory failure in the DFPF group after propensity matching as compared to control group (44% vs 22%, P = .02 1 ). Although DFPF is not able to remove free fatty acids, it is unlikely that it would actually increase the likelihood of persistent respiratory failure.…”

“…To the editor, Recently, Lu et al published a propensity score matched retrospective comparison of double filtration plasmapheresis (DFPF) and conservative management of patients with hypertriglyceridemic pancreatitis, 1 which is one of the largest non-randomized controlled studies in this field. They report rapid and efficient reduction of triglyceride levels with DFPF, but no beneficial effects on clinical outcomes of pancreatitis.…”