Early Plasmapheresis Among Patients With Hypertriglyceridemia-Associated Acute Pancreatitis

作者全名："Cao, Longxiang; Chen, Yingjie; Liu, Siyao; Huang, Wei; Wu, Dong; Hong, Donghuang; Wang, Zuozheng; Sun, Yi; Qin, Kaixiu; Guo, Feng; Luo, Cuizhu; Jiao, Qinghai; Luo, Xiang; Zhou, Jing; Li, Gang; Ye, Bo; Chen, Tao; Liu, Man; Mao, Wenjian; Wang, Lanting; Li, Shuai; Windsor, John A.; Liu, Yuxiu; Ke, Lu; Tong, Zhihui; Li, Weiqin"

作者地址："[Cao, Longxiang; Li, Gang; Ye, Bo; Wang, Lanting; Li, Shuai; Liu, Yuxiu; Ke, Lu; Tong, Zhihui; Li, Weiqin] Nanjing Univ, Sch Med, Jinling Hosp, Dept Crit Care Med, Nanjing, Peoples R China; [Cao, Longxiang; Liu, Man; Liu, Yuxiu; Ke, Lu; Li, Weiqin] Nanjing Univ, Natl Inst Healthcare Data Sci, Nanjing, Peoples R China; [Chen, Yingjie] Hosp Chengdu Univ Tradit Chinese Med, Dept Crit Care Med, Chengdu, Peoples R China; [Chen, Yingjie] Jinjiang Hosp Tradit Chinese Med, Dept Crit Care Med, Quanzhou, Peoples R China; [Liu, Siyao] Xiamen Univ, Affiliated Hosp 1, Dept Emergency Med, Xiamen, Peoples R China; [Huang, Wei] Sichuan Univ, West China Ctr Excellence Pancreatitis, Inst Integrated Tradit Chinese & Western Med, West China Liverpool Biomed Res Ctr,West China Ho, Chengdu, Peoples R China; [Wu, Dong] Chinese Acad Med Sci & Peking Union Med Coll, Peking Union Med Coll Hosp, State Key Lab Complex Severe & Rare Dis, Dept Gastroenterol, Beijing, Peoples R China; [Hong, Donghuang] Fujian Prov Hosp, Dept Crit Care Med, Fuzhou, Peoples R China; [Wang, Zuozheng] Ningxia Med Univ, Gen Hosp, Dept Hepatobiliary Surg, Yinchuan, Ningxia, Peoples R China; [Sun, Yi] Suining Cent Hosp, Ctr Digest Dis, Dept 4, Suining, Peoples R China; [Qin, Kaixiu] Chongqing Med Univ, Affiliated Hosp 2, Dept Emergency Med, Chongqing, Peoples R China; [Guo, Feng] Zhejiang Univ, Sch Med, Sir Run Run Shaw Hosp, Dept Intens Care Unit, Hangzhou, Peoples R China; [Luo, Cuizhu] Pingxiang Peoples Hosp, Dept Crit Care Med, Pingxiang, Peoples R China; [Jiao, Qinghai] First Hosp Handan, Dept Crit Care Med, Handan, Peoples R China; [Luo, Xiang] Fujian Med Univ, Longyan Affiliated Hosp 1, Dept Crit Care Med, Longyan, Peoples R China; [Zhou, Jing; Mao, Wenjian; Tong, Zhihui] Nanjing Med Univ, Jinling Hosp, Dept Crit Care Med, Nanjing, Peoples R China; [Chen, Tao] Univ Liverpool, Inst Populat Hlth, Dept Publ Hlth Policy & Syst, Liverpool, Merseyside, England; [Windsor, John A.] Univ Auckland, Fac Med & Hlth Sci, Surg & Translat Res Ctr, Auckland, New Zealand; [Liu, Yuxiu] Southern Med Univ, Sch Publ Hlth, Dept Biostat, Guangzhou, Peoples R China"

通信作者："Ke, L; Tong, ZH (通讯作者)，Jinling Hosp, Dept Crit Care Med, 305 Zhongshan East Rd, Nanjing 210000, Jiangsu, Peoples R China."

来源：JAMA NETWORK OPEN

ESI学科分类：　

WOS号：WOS:001059355500011

JCR分区：Q1

影响因子：10.5

年份：2023

卷号：6

期号：6

开始页：　

结束页：　

文献类型：Article

关键词：　

摘要："IMPORTANCE The incidence of hypertriglyceridemia-associated acute pancreatitis (HTG-AP) is increasing. Plasmapheresis is theoretically effective in removing triglyceride from plasma, but whether it confers clinical benefits is unclear. OBJECTIVE To assess the association between plasmapheresis and the incidence and duration of organ failure among patients with HTG-AP. DESIGN, SETTING, AND PARTICIPANTS This is an a priori analysis of data from a multicenter, prospective cohort study with patients enrolled from 28 sites across China. Patients with HTG-AP were admitted within 72 hours from the disease onset. The first patient was enrolled on November 7th, 2020, and the last on November 30th, 2021. The follow-up of the 300th patient was completed on January 30th, 2022. Data were analyzed from April to May 2022. EXPOSURES Receiving plasmapheresis. The choice of triglyceride-lowering therapies was at the discretion of the treating physicians. MAIN OUTCOMES AND MEASURES The primary outcome was organ failure-free days to 14 days of enrollment. Secondary outcomes included other measures for organ failure, intensive care unit (ICU) admission, duration of ICU and hospital stays, incidence of infected pancreatic necrosis, and 60-day mortality. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses were used to control potential confounders. RESULTS Overall, 267 patients with HTG-AP were enrolled (185 [69.3%] were male; median [IQR] age, 37 [31-43] years), among whom 211 underwent conventional medical treatment and 56 underwent plasmapheresis. PSM created 47 pairs of patients with balanced baseline characteristics. In the matched cohort, no difference was detected concerning organ failure-free days between patients undergoing plasmapheresis or not (median [IQR], 12.0 [8.0-14.0] vs 13.0 [8.0-14.0]; P = .94). Moreover, more patients in the plasmapheresis group required ICU admission (44 [93.6%] vs 24 [51.1%]; P < .001). The IPTW results conformed to the results from the PSM analysis. CONCLUSIONS AND RELEVANCE In this large multicenter cohort study of patients with HTG-AP, plasmapheresis was commonly used to lower plasma triglyceride. However, after adjusting for confounders, plasmapheresis was not associated with the incidence and duration of organ failure, but with increased ICU requirements."

基金机构：Key Research and Development Program Foundation of Jiangsu Province of China [BE2016749]; National Science Foundation of China [81900592]

基金资助正文：The study was funded partly by Key Research and Development Program Foundation of Jiangsu Province of China (No. BE2016749). This study was funded partly by the National Science Foundation of China (No. 81900592).