Impact of therapeutic plasmapheresis on the duration of organ failure in patients with hypertriglyceridemia-associated acute pancreatitis

Lanting Wang; Jing Zhou; Cheng Lv; Donghuang Hong; Zuozheng Wang; Wenjian Mao; Yuxiu Liu; Zixiong Zhang; Yuanzhen Li; Gang Li; Bo Ye; Baiqiang Li; Longxiang Cao; Zhihui Tong; Weiqin Li; Lu Ke; Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG)

doi:10.1186/s13613-024-01285-3

Impact of therapeutic plasmapheresis on the duration of organ failure in patients with hypertriglyceridemia-associated acute pancreatitis

Ann Intensive Care. 2024 Apr 15;14(1):57. doi: 10.1186/s13613-024-01285-3.

Authors

Lanting Wang^#^{1

2}, Jing Zhou^#³, Cheng Lv¹, Donghuang Hong⁴, Zuozheng Wang⁵, Wenjian Mao¹, Yuxiu Liu^{1

6

7}, Zixiong Zhang¹, Yuanzhen Li¹, Gang Li¹, Bo Ye¹, Baiqiang Li¹, Longxiang Cao^{8

9

10}, Zhihui Tong^{1

2}, Weiqin Li^{1

2

6}, Lu Ke^{11

12

13}; Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG)

Collaborators

Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG):
Qi Yang, Jiajia Lin, Lin Gao, Yan Chen, Nonghua Lv, Yin Zhu, Liang Xia, Wenhua He, Zhenping Chen, Xinting Pan, Qingyun Zhu, Youdong Wan, Hong Mei, Kang Li, Miao Chen, Chengjian He, Hongyi Yao, Zigui Zhu, Weili Lu, Weihua Gu, Feng Zhou, Shumin Tu, Long Fu, Bing Xue, Haibin Ni, Xiaofei Huang, Dandan Zhou, Guoxiu Zhang, Lening Ren, Dahuan Li, Xiangyang Zhao, Wei Zhao, Xiaomei Chen, Junli Sun, Keke Xin, Weiwei Chen, Qingcheng Xu, Jingchun Song, Qingbo Zeng, Min Shao, Dongsheng Zhao, Jianfeng Tu, Hongguo Yang, Bin Wu, Huaguang Ye, Mingzhi Chen, Mei Yang, Hong Gao, Qiang Li, Lijuan Zhao, Guobing Chen, Yafei Li, Honghai Xia, Dongliang Yang, Shusheng Zhou, Siyao Liu, Jiyan Lin, Songjing Shi, Weijie Yao, Shan Xu, Lei Yu, Feng Guo, Yongjun Lin, Yun Zhou, Yue Long, Guixian Luo, Quanxing Feng, Zhiyong Liu

Affiliations

¹ Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China.
² Research Institute of Critical Care Medicine and Emergency Rescue at Nanjing University, Nanjing, China.
³ Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.
⁴ Department of Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China.
⁵ Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, China.
⁶ National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.
⁷ Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China.
⁸ Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China. [email protected].
⁹ Research Institute of Critical Care Medicine and Emergency Rescue at Nanjing University, Nanjing, China. [email protected].
¹⁰ National Institute of Healthcare Data Science, Nanjing University, Nanjing, China. [email protected].
¹¹ Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China. [email protected].
¹² Research Institute of Critical Care Medicine and Emergency Rescue at Nanjing University, Nanjing, China. [email protected].
¹³ National Institute of Healthcare Data Science, Nanjing University, Nanjing, China. [email protected].

^# Contributed equally.

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.

Keywords: Acute pancreatitis; Hypertriglyceridemia; Organ failure; Plasmapheresis.

Abstract

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