The Role of Therapeutic Plasma Exchange in Treating Hypertriglyceridemia‐Associated Acute Pancreatitis: A Real‐World Effectiveness Analysis Using the TriNetX Global Collaborative Network
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2025
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| author | Nisar Amin Tim Carll Harleen Chela Amir Kamran Geoffrey D. Wool Ebubekir Daglilar |
| author_facet | Nisar Amin Tim Carll Harleen Chela Amir Kamran Geoffrey D. Wool Ebubekir Daglilar Nisar Amin Tim Carll Harleen Chela Amir Kamran Geoffrey D. Wool Ebubekir Daglilar |
| collection | Wiley Open Access |
| contents | The Role of Therapeutic Plasma Exchange in Treating Hypertriglyceridemia‐Associated Acute Pancreatitis: A Real‐World Effectiveness Analysis Using the TriNetX Global Collaborative Network Nisar Amin Tim Carll Harleen Chela Amir Kamran Geoffrey D. Wool Ebubekir Daglilar Journal of Clinical Apheresis ABSTRACTTherapeutic plasma exchange (TPE) is used to lower triglyceride levels in patients with severe hypertriglyceridemia‐associated acute pancreatitis (HTG‐AP). However, evidence supporting the effectiveness of TPE in preventing end‐organ damage remains limited. This retrospective cohort study was conducted using the TriNetX database to evaluate adults with acute pancreatitis, triglyceride levels > 1000 mg/dL, and “worrisome criteria”, defined as clinical indicators of disease severity such as fever, leukocytosis, elevated lactate, or signs of shock. Patients receiving TPE within 3 days of diagnosis were compared with patients with no TPE within 30 days. Outcomes included triglyceride reduction to < 500 mg/dL, ICU admission, end‐organ damage, and mortality. Of 14 188 patients with HTG‐AP, 3% (n = 419) received TPE; 97% (n = 13 237) were treated without TPE. After 1:1 propensity‐score matching, 2 well‐matched, 412‐patient cohorts were created. More patients in the TPE cohort had a reduction in triglyceride levels to < 500 mg/dL at 1 week (81% vs. 40%, p < 0.001) and 1 month (86% vs. 48%, p < 0.001). However, the TPE cohort also had higher ICU admission rates (39% vs. 19%, p < 0.001). No significant differences in organ failure rates were observed at 1 week (4.4% vs. 3.3%, p = 0.47) or 1 month (5.8% vs. 5.0%, p = 0.71). Similarly, 30‐day (4.4% vs. 6.3%, p = 0.21) and 3‐month (5.3% vs. 7.8%, p = 0.16) all‐cause mortality were comparable between the cohorts. In patients with HTG‐AP, use of TPE within 3 days of diagnosis reduces triglyceride levels effectively but does not significantly reduce the risk of end‐organ damage or mortality. TPE is associated with increased ICU care requirements, which may reflect protocolized ICU admission. 10.1002/jca.70053 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1002/jca.70053 |
| format | Artículo Open Access |
| id | wiley_oa_10_1002_jca_70053 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2025 |
| publisher | Wiley |
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| spellingShingle | The Role of Therapeutic Plasma Exchange in Treating Hypertriglyceridemia‐Associated Acute Pancreatitis: A Real‐World Effectiveness Analysis Using the TriNetX Global Collaborative Network Nisar Amin Tim Carll Harleen Chela Amir Kamran Geoffrey D. Wool Ebubekir Daglilar Journal of Clinical Apheresis The Role of Therapeutic Plasma Exchange in Treating Hypertriglyceridemia‐Associated Acute Pancreatitis: A Real‐World Effectiveness Analysis Using the TriNetX Global Collaborative Network Nisar Amin Tim Carll Harleen Chela Amir Kamran Geoffrey D. Wool Ebubekir Daglilar Journal of Clinical Apheresis ABSTRACTTherapeutic plasma exchange (TPE) is used to lower triglyceride levels in patients with severe hypertriglyceridemia‐associated acute pancreatitis (HTG‐AP). However, evidence supporting the effectiveness of TPE in preventing end‐organ damage remains limited. This retrospective cohort study was conducted using the TriNetX database to evaluate adults with acute pancreatitis, triglyceride levels > 1000 mg/dL, and “worrisome criteria”, defined as clinical indicators of disease severity such as fever, leukocytosis, elevated lactate, or signs of shock. Patients receiving TPE within 3 days of diagnosis were compared with patients with no TPE within 30 days. Outcomes included triglyceride reduction to < 500 mg/dL, ICU admission, end‐organ damage, and mortality. Of 14 188 patients with HTG‐AP, 3% (n = 419) received TPE; 97% (n = 13 237) were treated without TPE. After 1:1 propensity‐score matching, 2 well‐matched, 412‐patient cohorts were created. More patients in the TPE cohort had a reduction in triglyceride levels to < 500 mg/dL at 1 week (81% vs. 40%, p < 0.001) and 1 month (86% vs. 48%, p < 0.001). However, the TPE cohort also had higher ICU admission rates (39% vs. 19%, p < 0.001). No significant differences in organ failure rates were observed at 1 week (4.4% vs. 3.3%, p = 0.47) or 1 month (5.8% vs. 5.0%, p = 0.71). Similarly, 30‐day (4.4% vs. 6.3%, p = 0.21) and 3‐month (5.3% vs. 7.8%, p = 0.16) all‐cause mortality were comparable between the cohorts. In patients with HTG‐AP, use of TPE within 3 days of diagnosis reduces triglyceride levels effectively but does not significantly reduce the risk of end‐organ damage or mortality. TPE is associated with increased ICU care requirements, which may reflect protocolized ICU admission. 10.1002/jca.70053 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | The Role of Therapeutic Plasma Exchange in Treating Hypertriglyceridemia‐Associated Acute Pancreatitis: A Real‐World Effectiveness Analysis Using the TriNetX Global Collaborative Network |
| topic | Journal of Clinical Apheresis |
| url | https://onlinelibrary.wiley.com/doi/10.1002/jca.70053 |