Key result
Plasmapheresis improved 24-hour triglyceride reduction (SMD 0.58; 95% CI 0.17-0.99; P=0.005) but was associated with higher in-hospital mortality (RR 1.74; 95% CI 1.03-2.94) compared to conventional treatment.
Why the study?
The optimal treatment of hypertriglyceridemia-induced acute pancreatitis remains controversial regarding the use of plasmapheresis versus conventional treatment.
Does plasmapheresis improve outcomes in patients with hypertriglyceridemia-induced acute pancreatitis compared to conventional treatment?
Meta-Analysis (n=1,080)
Does plasmapheresis improve outcomes in patients with hypertriglyceridemia-induced acute pancreatitis compared to conventional treatment?
Standardized Mean Difference: 0.58 (95% CI 0.17–0.99)
p-value: p=0.005
Plasmapheresis for hypertriglyceridemia-induced acute pancreatitis reduces triglycerides faster but does not improve clinical outcomes and increases costs compared to conventional treatment.
Mortality signal warrants caution against routine use; leaves open net benefit in randomized trials of hypertriglyceridemia.
BACKGROUND: The treatment of acute pancreatitis (AP) induced by hypertriglyceridemia (HTG) remains controversial with regard to plasmapheresis vs conventional treatment. We reviewed relevant articles to explore the efficacy of plasmapheresis in the management of HTG-induced AP. METHODS: We systematically reviewed studies that compared plasmapheresis with conventional treatment for HTG-induced AP using three databases: PubMed, Embase, and Cochrane Library, as well as relevant references. The primary outcomes were 24 h triglyceride reduction rate and in-hospital mortality. RESULTS: A total of 791 articles were retrieved. Finally, 15 observational studies (1080 participants) were included, most of which were historical cohort studies. Compared with conventional treatment, plasmapheresis assisted in the reduction of serum triglyceride (TG) levels in the first 24 h after hospital admission (standardized mean difference [SMD]: 0.58; 95% confidence interval [CI]: 0.17 to 0.99; P = 0.005). However, it resulted in increased hospitalization costs (thousand yuan) (weighted mean difference [WMD]: 24.32; 95% CI: 12.96 to 35.68; P < 0.001). With regard to in-hospital mortality, although the mortality rate in the plasmapheresis group was higher than that in the conventional treatment group (relative risk [RR]: 1.74; 95% CI: 1.03 to 2.94; P = 0.038), the result was disturbed by confounding factors as per the subgroup and sensitivity analysis, as well as trial sequential analysis (TSA). No significant differences were found in other outcomes, including systematic complications, local complications, the requirement for surgery, and hospitalization duration. CONCLUSION: The effect of plasmapheresis in HTG-induced AP is not superior to that of conventional treatment, even resulting in a greater economic burden to patients and health care system. High quality randomized control trials are required to obtain a more a definitive understanding of this issue.
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Yan et al. (2022) conducted a meta-analysis in Hypertriglyceridemia-induced acute pancreatitis (n=1,080). Plasmapheresis vs. Conventional treatment was evaluated on 24 h triglyceride reduction rate and in-hospital mortality (SMD 0.58, 95% CI 0.17 to 0.99, p=0.005). Plasmapheresis improved 24-hour triglyceride reduction (SMD 0.58; 95% CI 0.17-0.99; P=0.005) but was associated with higher in-hospital mortality (RR 1.74; 95% CI 1.03-2.94) compared to conventional treatment.
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