Review Article

Management of Hypertriglyceridemia Induced Acute Pancreatitis

Table 1

Studies evaluating role of plasma exchange in treatment of HTG-AP.

AuthorStudy designSample sizeAgeM/FChange of TGSeverityReplacement fluidAnticoagulationMortalityComments

Lennertz et al. [58]Retrospective case series5343/2-74%NAAlbuminHeparin bolus 5/5,
Heparin infusion 3/5,
Citrate 2/5
0Successful treatment of One pregnant patients

Chen et al. [44]Retrospective comparison study60 (only 20 patints received PEX)42 ± 9NA-66%Ranson score >3 in 10 patientsFFP (8) and albumin (12)Heparin4No mortality benefit of PEX as compared to conservative treatment, no insulin described in control group

Yeh et al. [59]Case series1827-6513/5-66%NAAlbuminHeparin0PEX better in lowering TG as compared to double filtration

Yeh et al. [60]Retrospective study1731-5310/7-66%Ranson score 2FFP (8)/Albumin (9)Heparin2Initiation of treatment at 3 days of symptoms onset, Anaphylactoid shock in one patient, 89% reduction in lipase levels

Kadikoylu et al. [61]Case series747±35/2-46%AsymptomaticAlbuminCitrate0Asymtpomatic patients without any history of acute pancreatitis

Kyriakidis et al. [62]Retrospective10428/2-81%Apache II 13FFPCitrate1

Al-Humoud et a [63]Retrospective case series834±9.196/2-67%NAAlbuminHeparin0

Gubenšek et al [49]Retrospective case series5045±846/4-80%APACHE II 5AlbuminHeparin642% mortality in patients with APACHE II score ≥ 8,

Stefanutii et al [46]Retrospective multicenter case series1746 ± 109/8-61%NA/Resistant to conservative therapyAlbuminHeparin bolus followed by Citrate infusion012/17 patients had history of acute pancreatitis

Syed et al [64]Retrospective case series4363/1-89%Apache II score 8AlbuminNA0Fast lowering of TG but no clinical improvement

Ramírez-Bueno et al. [20]Retrospective case series1140 ± 86/5-81%APACHE II Score 13 (9-18)AlbuminNA3All 3 patients who died had APACHE II score > 15, Low TG levels in patients with severe pancreatitis

Gubenesek et al. [19]Retrospective observational cohort study11147 ± 997/14-59%4 (2-7)AlbuminCitrate (72) and Heparin (37)65 cases of hypotension and 5 cases of hypocalcemia with citrate anticoagulation, no difference between early and late plasmapheresis, better outcomes with citrate vs heparin group

NA: not available, FFP: fresh frozen plasma, APACHE II score: Acute Physiology and Chronic Health Evaluation score.