The Role of Therapeutic Plasma Exchange in Treating Hypertriglyceridemia-Associated Acute Pancreatitis: A Real-World Effectiveness Analysis Using the TriNetX Global Collaborative Network

Therapeutic plasma exchange (TPE) is used to lower triglyceride levels in patients with severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP). However, evidence supporting the effectiveness of TPE in preventing end-organ damage remains limited. This retrospective cohort study was conducted using the TriNetX database to evaluate adults with acute pancreatitis, triglyceride levels > 1000 mg/dL, and “worrisome criteria”, defined as clinical indicators of disease severity such as fever, leukocytosis, elevated lactate, or signs of shock. Patients receiving TPE within 3 days of diagnosis were compared with patients with no TPE within 30 days. Outcomes included triglyceride reduction to < 500 mg/dL, ICU admission, end-organ damage, and mortality. Of 14 188 patients with HTG-AP, 3% (n = 419) received TPE; 97% (n = 13 237) were treated without TPE. After 1:1 propensity-score matching, 2 well-matched, 412-patient cohorts were created. More patients in the TPE cohort had a reduction in triglyceride levels to < 500 mg/dL at 1 week (81% vs. 40%, p < 0.001) and 1 month (86% vs. 48%, p < 0.001). However, the TPE cohort also had higher ICU admission rates (39% vs. 19%, p < 0.001). No significant differences in organ failure rates were observed at 1 week (4.4% vs. 3.3%, p = 0.47) or 1 month (5.8% vs. 5.0%, p = 0.71). Similarly, 30-day (4.4% vs. 6.3%, p = 0.21) and 3-month (5.3% vs. 7.8%, p = 0.16) all-cause mortality were comparable between the cohorts. In patients with HTG-AP, use of TPE within 3 days of diagnosis reduces triglyceride levels effectively but does not significantly reduce the risk of end-organ damage or mortality. TPE is associated with increased ICU care requirements, which may reflect protocolized ICU admission.