Hypertriglyceridemic Pancreatitis: Conventional Treatment Versus Therapeutic Plasma Exchange

Abstract

Introduction: Acute pancreatitis (AP) induced by hypertriglyceridemia
(HTG) can be treated with therapeutic plasma exchange
(TPE), resulting in rapid reduction of triglyceride level.
However, there are no definitive comparative studies that
prove the real benefits of this therapy.
Objectives: Comparison of treatment methods (TPE versus
conventional) in patients with HTG AP during a period of 12
years (2000-2012).
Methods: Retrospective, descriptive and inferential analysis of
37 patients, evaluating: gender, age, personal pathologic history,
severity of disease, HTG values and evolution depending
on treatment with therapeutic plasma exchange (“TPE”) or
with conventional therapy (“C”).
Results: Both groups TPE and C demonstrated homogeneity
considering gender (p = 0.647), age (43.5 ± 9.74 years TPE vs
45.30 ± 9.90 years C; p = 0.320), prior AP episode (40% TPE
vs 40.7% C; p = 1.0), chronic alcohol consumption (50% TPE
vs 70.4% C; p = 0.275) and severity disease scores: APACHE
II (p = 0.054) and Ranson (p = 0.258). More than one secondary
HTG risk factor was presented in 45.95% of patients
. TPE group presented higher TG levels at admission: 4850
± 2802 mg/dL vs 1845 ± 1858 mg/dL (p = 0.001). No significant
statistical differences were observed considering length
of hospital stay [14.2 ± 6.8 days vs 13.5 ± 9.0 days (p = 0.56)]
or mortality rate (p = 0.47). At discharge, TG reduction was
greater in TPE group: 4433.70 ± 2896.08 mg/dL – 91.41% vs
1582.95 ± 2051.06 mg/dL – 83,92% (p = 0.002). Six minor
complications associated to TPE occurred.
Discussion/Conclusion: Despite the selection bias (retrospective
study), a greater TG reduction was observed with TPE
technique. Complications associated with the technique were
simple to resolve.