Impact of therapeutic plasmapheresis on the duration of organ failure in patients with hypertriglyceridemia-associated acute pancreatitis
Authors: Wang Lanting , Zhou Jing , Lv Cheng , Hong Donghuang , Wang Zuozheng , Mao Wenjian , Liu Yuxiu , Zhang Zixiong , Li Yuanzhen , Li Gang , Ye Bo , Li Baiqiang , Cao Longxiang , Tong Zhihui , Li Weiqin , Ke Lu ,   for the Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG), Yang Qi , Lin Jiajia , Gao Lin , Chen Yan , Lv Nonghua , Zhu Yin , Xia Liang , He Wenhua , Chen Zhenping , Pan Xinting , Zhu Qingyun , Wan Youdong , Mei Hong , Li Kang , Chen Miao , He Chengjian , Yao Hongyi , Zhu Zigui , Lu Weili , Gu Weihua , Zhou Feng , Tu Shumin , Fu Long , Xue Bing , Ni Haibin , Huang Xiaofei , Zhou Dandan , Zhang Guoxiu , Ren Lening , Li Dahuan , Zhao Xiangyang , Zhao Wei , Chen Xiaomei , Sun Junli , Xin Keke , Chen Weiwei , Xu Qingcheng , Song Jingchun , Zeng Qingbo , Shao Min , Zhao Dongsheng , Tu Jianfeng , Yang Hongguo , Wu Bin , Ye Huaguang , Chen Mingzhi , Yang Mei , Gao Hong , Li Qiang , Zhao Lijuan , Chen Guobing , Li Yafei , Xia Honghai , Yang Dongliang , Zhou Shusheng , Liu Siyao , Lin Jiyan , Shi Songjing , Yao Weijie , Xu Shan , Yu Lei , Guo Feng , Lin Yongjun , Zhou Yun , Long Yue , Luo Guixian , Feng Quanxing , Liu Zhiyong 
Published: April 2024

Abstract
Background
Plasmapheresis is widely used for severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP) to remove excessive triglycerides from plasma. This study aimed to evaluate whether plasmapheresis could improve the duration of organ failure in HTG-AP patients.

Methods
We analyzed a cohort of patients from a multicenter, prospective, long-running registry (the PERFORM) collecting HTG-AP patients admitted to the study sites within 72 h from the onset of symptoms. This study was based on data collected from November 2020 to March 2023. Patients who had organ failure at enrollment were involved in the analyses. The primary outcome was time to organ failure resolution within 14 days. Multivariable Cox regression model was used to evaluate the association between plasmapheresis and time to organ failure resolution. Directed acyclic graph (DAG) was used to identify potential confounders.

Results
A total of 122 HTG-AP patients were included (median [IQR] sequential organ failure assessment (SOFA) score at enrollment, 3.00 [2.00–4.00]). Among the study patients, 46 underwent plasmapheresis, and 76 received medical treatment. The DAG revealed that baseline serum triglyceride, APACHE II score, respiratory failure, cardiovascular failure, and renal failure were potential confounders. After adjusting for the selected confounders, there was no significant difference in time to organ failure resolution between patients undergoing plasmapheresis and those receiving exclusive medical treatment (HR = 1.07; 95%CI 0.68–1.68; P = 0.777). Moreover, the use of plasmapheresis was associated with higher ICU requirements (97.8% [45/46] vs. 65.8% [50/76]; OR, 19.33; 95%CI 2.20 to 169.81; P = 0.008).

Conclusions
In HTG-AP patients with early organ failure, plasmapheresis was not associated with accelerated organ failure resolution compared to medical treatment but may be associated with more ICU admissions.
Trial registration: The PERFORM study was registered in the Chinese Clinical Trial Registry (ChiCTR2000039541). Registered 30 October 2020.