Plasmapheresis in Acute Hypertriglyceridemia-Induced Pancreatitis-The PHIP-JuGa-Study.

Abstract

Background and aims: The incidence of acute pancreatitis is increasing in the Western world. About 10% of cases are caused by hypertriglyceridemia. Plasmapheresis was shown to reduce serum triglyceride (TG) levels, and current apheresis guidelines recommend its use in severe acute hypertriglyceridemia-induced pancreatitis (HIP). However, data on safety and efficacy are lacking. This study aimed to evaluate the clinical efficacy of plasmapheresis in hypertriglyceridemia-induced pancreatitis.

Methods: This is a retrospective multicenter cohort study of patients hospitalized for an episode of hypertriglyceridemia-induced pancreatitis from January 1, 2012 to December 31, 2022. The predefined composite primary endpoint was in-hospital mortality and organ failure. To reduce allocation bias, we performed propensity score matching.

Results: 245 episodes of hypertriglyceridemia-induced pancreatitis from 13 German centers were included. Of those, 95 episodes were treated with plasmapheresis. After propensity score matching, the final cohort consisted of 60 well-balanced pairs. Plasmapheresis was not associated with a difference in the primary composite outcome, in-hospital mortality, and organ failure (8/60 vs. 5/60; χ²(1) = 0.776; p = 0.378), nor was there any difference in the severity of pancreatitis episodes. It showed only a moderate reduction of serum triglyceride compared to the non-plasmapheresis group, but a significantly longer hospital stay in the plasmapheresis group (12 days; IQR 14 vs. 9 days; IQR 11; U = 1356; Z = -2.46; p = 0.014).

Conclusions: Plasmapheresis in patients with hypertriglyceridemia-induced pancreatitis was not associated with a better clinical outcome compared with conservative treatment in this propensity score-matched retrospective cohort study. Outside clinical studies, this costly and potentially complicative treatment should be considered with caution.