Early triglyceride-lowering therapy in acute pancreatitis with extremely high triglyceride levels.

Background: Initial triglyceride levels are likely to influence the effect of triglyceride-lowering therapy in hypertriglyceridemia-associated acute pancreatitis (HTG-AP).

Objective: This study aimed to evaluate whether timely triglyceride decline and different triglyceride-lowering therapies were associated with disease severity in HTG-AP patients with extremely high triglycerides.

Methods: In this registry-based cohort study, patients with on-admission triglyceride levels of 45.2 mmol/L or more were included. We grouped patients according to their post-treatment triglycerides on day 3 (target reaching, <5.65 mmol/L vs non target-reaching, ≥5.65 mmol/L) and triglyceride-lowering modality (plasmapheresis vs medical). The primary outcome was the development of severe acute pancreatitis (SAP). Multivariable logistic regression models were used to analyze the association between exposure variables and SAP. Generalized estimating equation models were used to examine repeated measures.

Results: Overall, 90 patients were included for analysis (median [IQR] initial triglycerides, 65.1 [53.8-77.5] mmol/L). Among the 80 patients with available triglycerides on day 3, 27 (33.8%) reached the target. After controlling for potential confounders, target reaching was significantly associated with decreased risk of SAP (odds ratio [OR], 0.12; 95% CI 0.02 to 0.59; P = .009). Compared to exclusive medical treatment, the use of plasmapheresis was not associated with the development of SAP (OR, 1.98; 95% CI 0.56 to 6.99; P = .291), nor with more rapid decline of triglyceride levels (mean difference 2.76 mmol/L; 95% CI -3.87 to 6.94; P = .577).

Conclusions: In HTG-AP patients with extremely high triglycerides, timely triglyceride decline was associated with reduced risk of SAP. Concerning treatment modality, plasmapheresis was not associated with fewer SAP, and the rapidity of triglyceride decline.