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

IF 5.7 1区医学 Q1 CRITICAL CARE MEDICINE

Annals of Intensive Care Pub Date : 2024-04-15 DOI:10.1186/s13613-024-01285-3

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

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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.

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治疗性血浆置换对高甘油三酯血症相关急性胰腺炎患者器官衰竭持续时间的影响

背景血浆置换术广泛用于重症高甘油三酯血症相关性急性胰腺炎（HTG-AP），以清除血浆中过多的甘油三酯。本研究旨在评估浆膜腔穿刺术是否能缩短 HTG-AP 患者器官衰竭的持续时间。方法我们分析了多中心、前瞻性、长期登记（PERFORM）中的患者队列，该登记收集了自症状出现起 72 小时内进入研究地点的 HTG-AP 患者。这项研究基于 2020 年 11 月至 2023 年 3 月收集的数据。入组时出现器官衰竭的患者参与了分析。主要结果是器官衰竭在14天内缓解的时间。多变量 Cox 回归模型用于评估血浆置换与器官衰竭缓解时间之间的关系。结果共纳入122例HTG-AP患者（入组时序贯器官衰竭评估（SOFA）评分的中位数[IQR]为3.00[2.00-4.00]）。研究患者中有 46 人接受了血浆置换术，76 人接受了药物治疗。DAG 显示，基线血清甘油三酯、APACHE II 评分、呼吸衰竭、心血管衰竭和肾衰竭是潜在的混杂因素。在对选定的混杂因素进行调整后，接受血浆置换术的患者与只接受药物治疗的患者在器官衰竭缓解时间上没有显著差异（HR = 1.07; 95%CI 0.68-1.68; P = 0.777）。结论在早期器官衰竭的HTG-AP患者中，与内科治疗相比，浆膜穿刺与加速器官衰竭缓解无关，但可能与更多的ICU入院有关：PERFORM研究已在中国临床试验注册中心注册（ChiCTR2000039541）。注册日期为2020年10月30日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Intensive Care CRITICAL CARE MEDICINE-

CiteScore

14.20

自引率

3.70%

发文量

107

审稿时长

13 weeks

期刊介绍： Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.

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