Key result
Plasmapheresis shows no benefit over standard therapy for in-hospital mortality in hypertriglyceridemia acute pancreatitis.
Why the study?
Hypertriglyceridemia acute pancreatitis is increasing and has a higher proportion of severe cases, but the benefit of plasmapheresis remains controversial.
Does plasmapheresis combined with standard medical therapy improve clinical outcomes in patients with hypertriglyceridemia acute pancreatitis?
Meta-Analysis (n=1,576)
Does plasmapheresis combined with standard medical therapy improve clinical outcomes in patients with hypertriglyceridemia acute pancreatitis?
Relative Risk: 1.43 (95% CI 0.91–2.26)
p-value: p=0.12
Plasmapheresis significantly reduces serum triglyceride levels in hypertriglyceridemia acute pancreatitis but does not improve critical clinical outcomes like mortality or complications, and increases length of stay and costs.
Plasmapheresis accelerates TG reduction but shows no outcome benefit and raises costs in HTG-AP; leaves open need for RCTs before practice change.
BACKGROUND: Hypertriglyceridemia acute pancreatitis (HTG-AP) is constantly increasing and has a higher proportion of severe cases. The benefit of plasmapheresis as a therapeutic intervention for HTG-AP remains controversial. Thus we conducted a meta-analysis to search existing evidence to evaluate its efficacy and safety. METHODS: A comprehensive literature search was performed in key electronic databases to search eligible studies based on predetermined criteria. Included studies compared plasmapheresis combined with standard medical therapy (Plasmapheresis group, PE group) versus standard medical therapy alone (Control group) in HTG-AP patients. Study outcomes were the 24-hour serum triglyceride (TG) reduction rate, in-hospital mortality, incidence of local/systemic complications, hospital length of stay (LOS), hospitalization costs, and recurrence rate. RESULTS: A total of 986 articles were retrieved and 20 studies involving 1,576 patients (PE group: n=636; Control group: n=940) were included. Analysis revealed that no statistically significant difference was found in mortality (RR 1.43, 95%CI 0.91-2.26, P=0.12), incidence of systemic complications (RR: 0.96; 95%CI: 0.61-1.50; P = 0.86), incidence of local complications (RR 1.01, 95% CI 0.84-1.21; P=0.91) , requirement for invasive procedures (RR 0.86, 95% CI 0.48-1.54, P=0.62) between PE group and Control group. PE group has higher TG reduction at both 24h (SMD 10.13, 95% CI 3.39-16.87, P<0.01) and 48h (SMD 8.14, 95%CI 4.30-11.98, P<0.0001) compared with control group. PE group exhibited a prolonged LOS (WMD 2.40, 95%CI 0.14-4.66, P=0.04) alongside substantially increased costs (WMD 27.56, 95%CI 16.61-38.51, P<0.00001). Subgroup analysis indicated plasmapheresis increased mortality in non-severe cases. CONCLUSION: While plasmapheresis significantly reduces serum TG levels, it confers no significant benefit on critical clinical outcomes in HTG-AP. Thus existing clinical evidence does not support its use as a routine treatment for HTG-AP. Large-scale RCTs should be carried out to further evaluate its efficacy, optimal indications, and timing.
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Cui et al. (2026) conducted a meta-analysis in Hypertriglyceridemia acute pancreatitis (n=1,576). Plasmapheresis vs. Standard medical therapy alone was evaluated on In-hospital mortality (RR 1.43, 95% CI 0.91-2.26, p=0.12). Plasmapheresis did not significantly improve in-hospital mortality compared to standard therapy alone in hypertriglyceridemia acute pancreatitis (RR 1.43; 95% CI 0.91-2.26; P=0.12).
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