Hypertriglyceridemia-associated Acute Pancreatitis: Apheresis Vs. Conservative Treatment
Condition: Acute Pancreatitis
MeSH terms: Pancreatitis; Hypertriglyceridemia
Study type: Observational

Summary: 
      Introduction: Hypertriglyceridemia is one of the etiologies of acute pancreatitis. It may
      cause severe multi-system disease resulting in high morbidity and mortality. There is
      controversy regarding the best method to treat it, which includes, among other therapies,
      high-dose insulin and performing plasma exchange (apheresis).

      Aims: Primary outcome - Comparison of 28- day mortality between hypertriglyceridemia-induced
      acute pancreatitis patients who received conservative therapy versus those who received
      apheresis therapy. Secondary outcomes: Comparison of morbidity parameters and rate of blood
      triglycerides level decrease between the groups.

      Materials and Methods: A retrospective study based on observational data collection, which
      will include all patients aged 18--99 who were admitted to the intensive care unit in
      2010-2020 in the diagnosis of acute pancreatitis secondary to high blood lipids. Data will be
      collected from hospital files and computerized systems. Data will include demographics,
      admission times, ventilation days, pressor support, 28- day mortality,daily triglyceride
      level, medical history, APACHE-2 score, lactate level, need for dialysis, need for
      antibiotics and surgical intervention. The study will include 29 patients. All demographic
      and patient parameters will be statistically examined by a qualified statistician depending
      on the type of data.
    

Detailed description: 
      Background: Hypertriglyceridemia causes 1-7% of all acute pancreatitis cases. The mechanism
      by which excess lipids in the blood cause pancreatitis is not entirely clear. The hypothesis
      is, that the enzyme lipase, which originates in the pancreas, causes increased breakdown of
      triglycerides into free fatty acids, which are toxic to endothelial cells and pancreatic
      acinary cells. In addition, excess fat in the blood increases blood viscosity and impairs
      blood flow to the pancreas, thus causing necrosis.

      There is controversy regarding the best way to treat pancreatitis secondary to
      hypertriglyceridmia. In addition to fasting, intravenous fluids and analgesia, a number of
      methods have been used to lower blood lipids, such as heparin and insulin or plasma exchange.
      Performing plasma exchange causes rapid removal of lipids from the plasma, but it is not yet
      accepted as the treatment of choice, as there are so far no random prospective studies that
      have shown an advantage for this treatment method over conservative methods.

      The American Society of apheresis defines plasma exchange as a Category 3 indication for the
      treatment of acute pancreatitis secondary to hyperlipidemia, i.e. as a treatment method whose
      effectiveness has not been unequivocally proven, and its use is at the discretion of the
      treating physician.

      In the last ten years, the intensive care unit at our institution has treated 29 patients who
      were admitted due to hypertriglyceridemia induced acute pancreatitis. Some patients were
      treated conservatively, and some were treated by plasma exchange. We would like to
      investigate whether there was a difference in mortality rates and morbidity parameters
      between the groups.

      Aims: The primary outcome of this study was to compare 28-days mortality rates among patients
      who received apheresis versus those who did not. Secondary outcomes were comparison of
      morbidity parameters between the groups: APACHE score, ICU and hospital length of stay,
      ventilation days, pressor support, need for renal replacement therapy, need for antibiotics,
      need for surgical of minimally invasive intervention, and rate of blood triglycerides
      decrease.

      Materials and methods: A retrospective study among patients who were admitted to the ICU
      between years 2010-2020 due to hypertriglyceridemia-induced acute pancreatitis, a total of 29
      cases. Data will be collected from hospital files and computer systems (Chameleon system and
      iMDsoft software).

      Inclusion criteria: All patients aged 18-99 who were admitted to the intensive care unit in
      Meir medical hospital between years 2010-2020, whose cause of admission was
      hypertriglyceridemia-induced acute pancreatitis, defined as abdominal pain, elevated levels
      of amylase and lipase and blood triglyceride level above 1000 mg/dl, without any other
      apparent etiology of pancreatitis.

      Collected data: Patient demographics and medical history including chronic pharmacologic
      therapy, hospital admission times, ventilation days, inotropic therapy, hemodialysis, daily
      blood triglyceride level, 28-day mortality, APACHE 2 score, lactate level, antibiotic therapy
      and need for surgical intervention. All data will be statistically analyzed according to type
      of data
    

Intervention name(s): conservative versus plasmapharesis therapy
Intervention type(s): Other
Intervention description(s): conservative versus plasmapharesis therapy
Observational model: Other
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        All patients aged 18-99 who were admitted to the intensive care unit in Meir medical
        hospital between years 2010-2020, whose cause of admission was hypertriglyceridemia-induced
        acute pancreatitis, defined as abdominal pain, elevated levels of amylase and lipase and
        blood triglyceride level above 1000 mg/dl, without any other apparent etiology of
        pancreatitis.

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