Plasmapheresis therapy has no triglyceride-lowering effect in patients with hypertriglyceridemic pancreatitis

Miyamoto, Kyohei; Horibe, Masayasu; Sanui, Masamitsu; Sasaki, Mitsuhito; Sugiyama, Daisuke; Kato, Seiya; Yamashita, Takahiro; Goto, Takashi; Iwasaki, Eisuke; Shirai, Kunihiro; Oe, Kyoji; Sawano, Hirotaka; Oda, Takuya; Yasuda, Hideto; Ogura, Yuki; Hirose, Kaoru; Kitamura, Katsuya; Chiba, Nobutaka; Ozaki, Tetsu; Oshima, Taku; Yamamoto, Tomonori; Nagata, Keiji; Mine, Tetsuya; Saito, Koji; Sekino, Motohiro; Furuya, Tomoki; Matsuda, Naoyuki; Hayakawa, Mineji; Kanai, Takanori; Mayumi, Toshihiko

doi:10.1007/s00134-017-4722-3

Cited by 34 publications

(36 citation statements)

References 4 publications

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“…The 22 episodes of HTG-associated pancreatitis in our series had a calculated fall in serum TG of 69.8% by 48 h. This rate of decline is similar to those reported in plasmapheresis case series, which demonstrated 49-80% reductions in serum TG after a single session [2, 5,6,20,30,33,34,36,39,48,53,54,[58][59][60]. These findings are also consistent with other observational reports that showed no difference in the rate of TG decline between patients managed with or without plasmapheresis [47]. Furthermore, our observed plasma TG half-life of 30.6 h is an expected physiologic response to the elimination of oral fat in patients who do not have complete LPL deficiency.…”

Section: Discussionsupporting

confidence: 91%

“…Plasmapheresis has been suggested as a consideration for the management of HTG-associated pancreatitis, despite the lack of well-designed trials confirming its benefit. Whilst plasmapheresis may hasten the TG decline, this was not observed in a recent comparison series [47]. Furthermore, TG levels fall rapidly without any intervention other than supportive management and withholding oral intake.…”

Section: Discussionmentioning

confidence: 89%

“…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%

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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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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Conservative management in hypertriglyceridemia‐associated pancreatitis

et al. 2019

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“…However, many studies have found that PP does not improve mortality rates among patients with HLAP [9,10]. Moreover, a recent retrospective study found that PP therapy had no additional TG-lowering effects in patients with HLAP [11]. In addition, PP requires special treatment equipment, is expensive, and involves some risks, such as plasma allergy, bleeding and infection [12].…”

Section: Introductionmentioning

confidence: 99%

Total Cholesterol Concentration Predicts the Effect of Plasmapheresis on Hypertriglyceridemic Acute Pancreatitis

Zhu¹,

Huang²,

Han³

et al. 2020

Preprint

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Background The clinical efficacy of plasmapheresis (PP) in patients with hypertriglyceridemic acute pancreatitis (HLAP) might affected by total cholesterol (TC). The objective of this study is to determine the relationship of TC and the Triglyceride (TG)-lowing effect in patients on either non-PP or PP therapy.MethodsPatients were categorized into high total cholesterol (HTC) /low total cholesterol (LTC) groups based on TC level of 12.4 mmol/l. The primary outcome was TG reduction to below 500mg/dl within 48 hours. Linear mixed-effect model and logistic regression analyses were used to assess the association of TC and different therapy groups on TG-lowing efficacy.ResultsCompared with LTC group, patients with HTC showed more severe imaging manifestations(p<0.001) and higher APACH Ⅱ scores (p=0.036). Deaths occurred only in HTC groups. Significant interaction of time sequence with the 2 TGs-lowing therapy groups on TG level was only found in HTC group (p < 0.001). In patients with elevated TC level, primary outcome occurred in 66.67% of patients in the PP group, and 27.91% in the non-PP group. After adjustment for age, gender, CT grade and APACH II score, the odd ratio remain significant (OR 5.47, 95% confidence interval [CI] 1.84-16.25, p = 0.002). Furthermore, in patients with lower TC level, primary outcome occurred in 81.25% of patients in the PP group, and 62.30% in the non-PP group (adjusted OR 2.05; 95% CI 0.45–9.40; p = 0.353).Conclusions: TC could be a potential biomarker to predict the effects of TG-lowing therapy in patients with HLAP.

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“…The proportion of cases attributable to hypertriglyceridaemia (HTG) is reported between 1% and 9%. [2][3][4] Causes of HTG can be categorized into primary genetic defects in lipid metabolism or secondary factors such as uncontrolled diabetes, pregnancy, obesity or alcoholism. In the case of HTG-induced pancreatitis, a combination of genetic susceptibility exacerbated by secondary factors is present in most patients.…”

Section: Introductionmentioning

confidence: 99%

Anti‐lipid therapy and risk factor management for triglyceridaemia‐induced acute pancreatitis

Tabone

Burstow

Vardesh

et al. 2020

ANZ Journal of Surgery

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Background: Pancreatitis secondary to hypertriglyceridaemia is rare, accounting for less than 5% of pancreatitis presentations. We reviewed our institutional experience with triglyceridaemia induced acute pancreatitis to report the clinical presentation, patient demographics and clinical management. Methods: The Acute Surgical Unit database at a high-volume general surgical referral centre was queried to identify cases of acute pancreatitis secondary to hypertriglyceridaemia between 2016 and 2019. Patient demographics, clinical manifestations, biochemical derangements and treatment regimens were analysed. Current related literature was reviewed. Results: There were 496 presentations for acute pancreatitis of which 14 presentations (2.8%), amongst 12 patients were due to hypertriglyceridaemia. The mean triglyceride level at presentation was 92.46 (standard deviation 46.9) mmol/L. Ten patients (83%) had poorly controlled type 2 diabetes. All patients were managed using conservative therapy combined with a restricted fat diet and commenced on long-term anti-lipid therapy to manage associated risk factors. In addition, 10 patients received an insulin infusion and one patient received insulin infusion, plasmapheresis and heparin infusion in combination. The median length of hospital stay was 5.5 (range 3-13) days. Two patients (16%) developed a recurrent episode related to non-compliance to medical therapy. Conclusion: Hypertriglyceridaemia is a rare cause of acute pancreatitis. Successful management involves the treatment of acute pancreatitis in conjunction with long-term anti-lipid therapy and optimisation of associated risk factors.

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Plasmapheresis therapy has no triglyceride-lowering effect in patients with hypertriglyceridemic pancreatitis

Cited by 34 publications

References 4 publications

Conservative management in hypertriglyceridemia‐associated pancreatitis

Conservative management in hypertriglyceridemia‐associated pancreatitis

Total Cholesterol Concentration Predicts the Effect of Plasmapheresis on Hypertriglyceridemic Acute Pancreatitis

Anti‐lipid therapy and risk factor management for triglyceridaemia‐induced acute pancreatitis

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