Double Filtration Plasma Apheresis Shortens Hospital Admission Duration of Patients With Severe Hypertriglyceridemia-Associated Acute Pancreatitis.
OBJECTIVE
The treatment effectiveness of double filtration plasma apheresis (DFPP) on severe hypertriglyceridemia-associated acute pancreatitis (STAP) has been questioned because the currently defined serum triglyceride level--1000 mg/dL--is too low for STAP. Given this, we aimed to investigate DFPP effectiveness when we elevated STAP definition to 5000 mg/dL serum triglyceride.


METHODS
We performed nested case-control studies for STAP patients and divided them into groups "with" or "without" DFPP. We further recruited outpatient asymptomatic hypertriglyceridemia patients with STAP history, then divided them into groups "with" or "without" prophylactic DFPP once every 3 to 6 months for 2 years. We observed hospitalization duration and STAP recurrence between patients with and patients without DFPP.


RESULTS
Twelve STAP patients receiving DFPP had a median hospitalization of 5 days, whereas 24 patients without DFPP had 10 days (P = 0.009). Six outpatient referrals with STAP history receiving prophylactic DFPP showed no STAP recurrences whereas 6 without DFPP showed 3 recurrences (P = 0.046). For the 25 patients whose serum triglyceride exceeded 5000 mg/dL, 11 receiving DFPP had median hospitalization of 5 days while 14 without DFPP had 11 days (P = 0.012).


CONCLUSIONS
When applied to serum triglyceride in excess of 5000 mg/dL, DFPP removes oxidized and inflammatory lipoproteins, shortens hospitalization duration, and minimizes STAP recurrence.
From the *College of Medicine, China Medical University; †Division of Nephrology, ‡L5 Research Center, §Division of Gastroenterology, ∥Proteomic Core Laboratory, China Medical University Hospital; and ¶Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
Chiz-Tzung
CT
Chang
Tsung-Yu
TY
Tsai
Hsin-Yi
HY
Liao
Chia-Ming
CM
Chang
Jyun-Shan
JS
Jheng
Wen-Hsin
WH
Huang
Che-Yi
CY
Chou
Chao-Jung
CJ
Chen
D000208:Acute Disease; D000328:Adult; D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D016022:Case-Control Studies; D002460:Cell Line; D018932:Chemokine CCL2 / Q000378:metabolism; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000150:complications / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008074:Lipoproteins / Q000097:blood / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000166:cytology / Q000187:drug effects / Q000378:metabolism; D010195:Pancreatitis / Q000097:blood / Q000150:complications / Q000628:therapy*; D010956:Plasmapheresis / Q000379:methods*; D051381:Rats; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
C491766:Ccl2 protein, rat; D018932:Chemokine CCL2; D008074:Lipoproteins; D014280:Triglycerides