Plasmapheresis for Recurrent Acute Pancreatitis from Hypertriglyceridemia

Kopecky, Kathleen F.; Moreland, Amber; Hebert, Christopher; Colbert, Gates B.

doi:10.1080/08998280.2017.11929648

Cited by 5 publications

(4 citation statements)

References 6 publications

(5 reference statements)

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“…In clinical practice, about 80% of the common etiologies are attributed to gallstones and alcohol consumption[ 3 ], however, the proportion of different etiologies significantly varies among different countries. In addition, hypertriglyceridemia is a high-risk factor for AP, and may lead to direct damage to pancreas and pancreatic exocrine function[ 4 , 5 ]. Thus, identification of etiologies is highly essential to manage better AP patients.…”

Section: Introductionmentioning

confidence: 99%

Effects of acute kidney injury on acute pancreatitis patients’ survival rate in intensive care unit: A retrospective study

Shi

Sun

et al. 2021

WJG

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BACKGROUND Acute kidney injury (AKI) is one of the most common acute pancreatitis (AP)-associated complications that has a significant effect on AP, but the factors affecting the AP patients’ survival rate remains unclear. AIM To assess the influences of AKI on the survival rate in AP patients. METHODS A total of 139 AP patients were included in this retrospective study. Patients were divided into AKI group ( n = 72) and non-AKI group ( n = 67) according to the occurrence of AKI. Data were collected from medical records of hospitalized patients. Then, these data were compared between the two groups and further analysis was performed. RESULTS AKI is more likely to occur in male AP patients ( P = 0.009). AP patients in AKI group exhibited a significantly higher acute physiologic assessment and chronic health evaluation II score, higher Sequential Organ Failure Assessment score, lower Glasgow Coma Scale score, and higher demand for mechanical ventilation, infusion of vasopressors, and renal replacement therapy than AP patients in non-AKI group ( P < 0.01, P < 0.01, P = 0.01, P = 0.001, P < 0.01, P < 0.01, respectively). Significant differences were noted in dose of norepinephrine and adrenaline, duration of mechanical ventilation, maximum and mean values of intra-peritoneal pressure (IPP), maximum and mean values of procalcitonin, maximum and mean serum levels of creatinine, minimum platelet count, and length of hospitalization. Among AP patients with AKI, the survival rate of surgical intensive care unit and in-hospital were only 23% and 21% of the corresponding rates in AP patients without AKI, respectively. The factors that influenced the AP patients’ survival rate included body mass index (BMI), mean values of IPP, minimum platelet count, and hospital day, of which mean values of IPP showed the greatest impact. CONCLUSION AP patients with AKI had a lower survival rate and worse relevant clinical outcomes than AP patients without AKI, which necessitates further attention to AP patients with AKI in surgical intensive care unit.

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Section: Introductionmentioning

confidence: 99%

Effects of acute kidney injury on acute pancreatitis patients’ survival rate in intensive care unit: A retrospective study

Shi

Sun

et al. 2021

WJG

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“…Heparin and/or insulin infusions have been successfully used in cases of HTG‐related pancreatitis, especially when hyperglycaemia was present . Uncontrolled and retrospective case reports and series showed reduced TG levels following plasmapheresis , but minimal outcome data. A systematic review of apheresis used in HTG‐associated pancreatitis could not determine benefit for morbidity, mortality or pancreatitis severity .…”

Section: Introductionmentioning

confidence: 99%

Conservative management in hypertriglyceridemia‐associated pancreatitis

et al. 2019

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Background Severe hypertriglyceridemia (serum triglyceride >10 mmol L−1) is implicated in ~9% of acute pancreatitis cases. Certain guidelines list severe hypertriglyceridemia as an indication for plasmapheresis. Objective We assembled the natural trajectory of triglyceride levels in patients with acute pancreatitis due to severe hypertriglyceridemia who were managed conservatively without plasmapheresis to evaluate the effectiveness of this approach. Methods A retrospective chart review was performed on 22 hospital admissions for acute pancreatitis episodes considered to be caused by severe hypertriglyceridemia. Patients were managed supportively, with cessation of oral intake (NPO) and intravenous hydration. Insulin infusion was used in 12 patients to manage concurrent hyperglycaemia. Results Triglyceride levels for the group were evaluated using a mixed‐effects model. The average triglyceride level fell from 45.4 mmol L−1 on presentation to 13.3 mmol L−1 within 48 h, corresponding to a mean 69.8% decrease. Regression analysis showed a triglyceride half‐life of 30.6 h. Findings were similar for NPO‐only and insulin infusion subgroups. Conclusion Patients with severe hypertriglyceridemia and acute pancreatitis can be conservatively managed safely and effectively without plasmapheresis.

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“…The main objective of these techniques is to selectively eliminate molecules of medium molecular weight, such as cytokines (17). The use of TPE to treat thyroid storm and pancreatitis has also been reported (18,19). In this paper, we have described a patient with r/r ALL who developed severe, life-threatening CRS after an infusion of anti-CD19 CAR-T cells.…”

Section: Discussionmentioning

confidence: 97%

Plasma Exchange Can Be an Alternative Therapeutic Modality for Severe Cytokine Release Syndrome after Chimeric Antigen Receptor-T Cell Infusion: A Case Report

Xiao

et al. 2019

Clinical Cancer Research

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Background: Tumor immunotherapy with chimeric antigen receptor-T cells (CAR-T) is a promising new treatment for B-cell malignancies and has produced exciting results. However, cytokine release syndrome (CRS) is the most significant toxicity associated with this treatment and can be lifethreatening. Case Presentation: A 23-year-old male patient had been diagnosed with relapsed and refractory B-cell acute lymphocytic leukemia. The patient was recruited into our CART clinical trial, and 1 Â 10 6 /kg of engineered anti-CD19 CART cells was administered. After infusion of CART cells (day 0), the patient underwent a typical CRS reaction, with increases in fever, muscle soreness, and inflammatory cytokines. He was treated with antiallergic and antipyretic drugs, glucocorticoids, and tocilizumab (4 mg/kg, days 3 and 5). However, CRS was not under control, and his condition rapidly deteriorated. He was transferred to the intensive care unit, where dexamethasone 10 mg q6h was administered, and plasma exchange was performed, with 3,000 mL of plasma replaced by fresh frozen plasma per day for 3 consecutive days. His symptoms gradually improved, and the CRS-related symptoms were relieved. Additionally, a bone marrow smear showed no lymphoblast cells, and minimal residual disease was negative on day 28. The patient was eventually discharged in a normal condition. Conclusions: CRS is caused by an exaggerated systemic immune response, potentially resulting in organ damage that can be fatal. Although therapeutic plasma exchange is not included in CRS management guidelines, this case shows that plasma exchange is feasible in at least some patients with severe CRS.

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Plasmapheresis for Recurrent Acute Pancreatitis from Hypertriglyceridemia

Cited by 5 publications

References 6 publications

Effects of acute kidney injury on acute pancreatitis patients’ survival rate in intensive care unit: A retrospective study

Effects of acute kidney injury on acute pancreatitis patients’ survival rate in intensive care unit: A retrospective study

Conservative management in hypertriglyceridemia‐associated pancreatitis

Plasma Exchange Can Be an Alternative Therapeutic Modality for Severe Cytokine Release Syndrome after Chimeric Antigen Receptor-T Cell Infusion: A Case Report

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