Early Plasmapheresis Among Patients With Hypertriglyceridemia–Associated Acute Pancreatitis
Authors: Cao Longxiang , Chen Yingjie , Liu Siyao , Huang Wei , Wu Dong , Hong Donghuang , Wang Zuozheng , Sun Yi , Qin Kaixiu , Guo Feng , Luo Cuizhu , Jiao Qinghai , Luo Xiang , Zhou Jing , Li Gang , Ye Bo , Chen Tao , Liu Man , Mao Wenjian , Wang Lanting , Li Shuai , Windsor John A. , Liu Yuxiu , Ke Lu , Tong Zhihui , Li Weiqin ,   Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG), Song Jingchun , Zeng Qingbo , Gu Weili , Chen Weiwei , Xu Qingcheng , Chen Guobing , Li Yafei , Zhao Lijuan , Shi Songjing , Yao Weijie , Huang Xiaofei , Ni Haibin , Zhou Dandan , Chen Mingzhi , Chen Yan , Huang Mingfeng , Li Baiqiang , Lin Jiajia , Lu Mengjie , Sun Junli , Xin Keke , He Chengjian , Yao Hongyi , Zhu Zigui , Shao Fang , Zhou Yun , Luo Guixian , Chen Xiaomei , Zhao Xiangyang , Zhao Wei , Fu Long , Tu Shumin , Xue Bing , Lin Yongjun , Pan Xinting , Wan Youdong , Zhu Qingyun , Chen Miao , Li Kang , Mei Hong , Li Dahuan , Ren Lening , Zhang Guoxiu , Shao Min , Zhao Dongsheng , Chen Zhenping , He Wenhua , Lv Nonghua , Xia Liang , Zhu Yin , Li Qiang , Xia Honghai , Yang Dongliang , Zhou Shusheng , Lu Weihua , Wu Jingyi , Zhou Feng , Lin Jiyan , Feng Quanxing , Yang Mei , Gao Hong , Xu Shan , Yu Lei , Wu Bin , Ye Huaguang , Liu Zhiyong , Tu Jianfeng , Yang Hongguo 
Published: June 2023

Importance

The incidence of hypertriglyceridemia–associated acute pancreatitis (HTG-AP) is increasing. Plasmapheresis is theoretically effective in removing triglyceride from plasma, but whether it confers clinical benefits is unclear.

Objective

To assess the association between plasmapheresis and the incidence and duration of organ failure among patients with HTG-AP.

Design, Setting, and Participants

This is an a priori analysis of data from a multicenter, prospective cohort study with patients enrolled from 28 sites across China. Patients with HTG-AP were admitted within 72 hours from the disease onset. The first patient was enrolled on November 7th, 2020, and the last on November 30th, 2021. The follow-up of the 300th patient was completed on January 30th, 2022. Data were analyzed from April to May 2022.

Exposures

Receiving plasmapheresis. The choice of triglyceride-lowering therapies was at the discretion of the treating physicians.

Main Outcomes and Measures

The primary outcome was organ failure–free days to 14 days of enrollment. Secondary outcomes included other measures for organ failure, intensive care unit (ICU) admission, duration of ICU and hospital stays, incidence of infected pancreatic necrosis, and 60-day mortality. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses were used to control potential confounders.

Results

Overall, 267 patients with HTG-AP were enrolled (185 [69.3%] were male; median [IQR] age, 37 [31-43] years), among whom 211 underwent conventional medical treatment and 56 underwent plasmapheresis. PSM created 47 pairs of patients with balanced baseline characteristics. In the matched cohort, no difference was detected concerning organ failure–free days between patients undergoing plasmapheresis or not (median [IQR], 12.0 [8.0-14.0] vs 13.0 [8.0-14.0]; P = .94). Moreover, more patients in the plasmapheresis group required ICU admission (44 [93.6%] vs 24 [51.1%]; P &amp;lt; .001). The IPTW results conformed to the results from the PSM analysis.

Conclusions and Relevance

In this large multicenter cohort study of patients with HTG-AP, plasmapheresis was commonly used to lower plasma triglyceride. However, after adjusting for confounders, plasmapheresis was not associated with the incidence and duration of organ failure, but with increased ICU requirements.