Treatment Of Hypertriglyceridemia-induced Acute Pancreatitis Research Articles

Tratamiento de la hipertrigliceridemia grave mediante recambio plasmático terapéutico en pacientes con pancreatitis aguda o en riesgo de padecerla

Introduction and objectivesTPE drastically reduces serum triglyceride (sTG), but its role in the treatment of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) or at risk of developing it, is not well established. The objectives were to assess the effectiveness and safety of TPE in the treatment of severe HTG (sHTG), as well as to evaluate the severity of HTG-AP treated with TPE. Materials and methodsObservational-retrospective-single-center study, in which a descriptive analysis of sHTG treated with TPE was conducted, with the aim of treating HTG-AP or preventing its recurrence. TPE was performed if sTG≥ 1000 mg/dL after 24 hours of admission. Results42 TPE were performed to treat 35 sHTG in 23 patients: 29 HTG-AP, and 6 sHTG with previous HTG-AP. Among the patients, 37% (13/55) were women, with 37 ± 14 years-old, 74.3% had normal BMI (25/35), 34% (12/35) were drinking > 40 g/alcohol/day and 54% (19/35) were diabetics. TPE significantly reduced the baseline sTG (4425 ± 2782 mg/dL vs. 709 ± 353 mg/dL, p < 0.001) in a single session, achieving a mean percentage reduction of 79 ± 13%; 20% (7/35) of sHTG cases required two TPE sessions to reduce sTG to < 1000 mg/dL. Adverse effects were reported in 4/42 TPE sessions (9,5%). sHTG-AP was observed in 3% of cases (1/29), and there were no deaths. sTG at 24 hours of admission showed no relation with the severity of APs. ConclusionThe treatment of sHTG with TPE, with the aim of treating HTG-AP or preventing its recurrence, reduces sTG quickly and safety.

Comparative analysis of therapeutic plasma exchange vs. standard management in hypertriglyceridemia-induced acute pancreatitis: triglyceride reduction and clinical outcomes.

The use of therapeutic plasma exchange (TPE) for treatment of hypertriglyceridemia-induced acute pancreatitis (HTGP) remains controversial in the literature. This study compared the clinical outcomes of TPE versus conventional therapy in patients with HTGP. Fifty-five patients with HTGP were included. Patients were retrospectively compared in pairs: those who received TPE treatment and those who did not, those whose triglyceride level fell below 500mg/dL within 48h, and those who did not, those with and without persistent organ failure. The primary outcome was the percentage of triglyceride reduction within 48h. Secondary outcomes were the length of hospital stay, mortality, cost-effectiveness, and persistent organ failure. Percentage decrease in triglyceride levels, medical hospitalization costs, and length of hospital stay were higher in the TPE group compared to the non-TPE group (p < 0.05, for each). However, there was no difference regarding persistent organ failure and mortality (p > 0.05, for each). The length of hospital stay, average cost, persistent organ failure, and mortality were similar in both groups whose triglyceride level fell below 500mg/dL within 48h and those who did not (p > 0.05, for each). Among patients with persistent organ failure, average cost was higher in the TPE group compared to the non-TPE group (p < 0.05). An independent relation was found between the average cost and persistent organ failure, TPE, length of hospital stay, albumin, and urea values in all patients (p < 0.05, for each). The approach of using TPE for treatment of HTGP was not found to be superior to the conventional treatment. Randomized controlled studies with larger number of patients are needed to gain better understanding of this issue.

Blood Purification for Hypertriglyceridemia-Induced Acute Pancreatitis: A Meta-analysis.

The purpose of our study is to investigate the efficacy and safety of blood purification (BP) therapy in hypertriglyceridemia-induced acute pancreatitis. We searched PubMed, Embase, Cochrane Library, and Web of Science databases for articles published. The analysis included 13 studies with 934 patients (263 in BP group, 671 in control group). There was no difference in efficacy and safety between the BP group and the control group (all P > 0.05). Compared with conventional treatment, BP had shorter hospital stay (mean difference, -4.96; 95% confidence interval [CI], -8.81 to -1.11; P = 0.01) in the case of similar mortality and complications. Meanwhile, insulin treatment showed similar mortality to BP, but fewer local complications (odds risk, 2.18; 95% CI, 1.13-4.20; P = 0.02) and shorter hospital stay (mean difference, 5.46; 95% CI, 0.64-10.29; P = 0.03). In the treatment of hypertriglyceridemia-induced acute pancreatitis, BP methods are effective in accelerating triglyceride level reduction and shortening hospital stay but do not affect the efficacy or reduce mortality significantly compared with conventional treatment. Insulin therapy has the same effect as BP but decreases incidence of complications and cost.

Metformin Combined LMWH Intervention in 25 Pregnant Women with History of Hyperlipidemia Pancreatitis in Pregnancy

Objective: To explore the early preventive treatment of hypertriglyceridemia-induced acute pancreatitis (HTGP) in pregnancy. Methods: A retrospective cohort analysis was performed to examine the drug intervention on recurrent HTGP and related pregnancy outcomes among women who had HTGP in their past pregnancy and developed hyperlipidemia during the second pregnancy. Participants were identified through inpatient case records under a single physician at the clinic and divided into two groups. The intervention group was given metformin lipid-lowering combined with low-molecular-weight heparin to prevent thrombosis when hypertriglyceridemia was developed during the pregnancy. In contrast, the non-intervention group includes those who did not receive active drug treatment until they developed recurrent HTGP. Metabolic markers were also examined by comparing them with their respective past pregnancies. Results: All participants experienced elevated triglycerides during their two consecutive pregnancies. No pregnant women developed HTGP in the intervention group (n=12), while 10 of 13 (76.9%) women developed HTGP in the non-intervention group. Thus, the outcome seemed to be markedly different. In the intervention group, 11 women were gestated to term, and one was premature; one of 12 (8.3%) births was neonatal asphyxia; there was no low-weight birth, and the prognosis of mother and baby was favorable. Of 10 women who developed recurrent HTGP in the non-intervention group, four suffered from fetal loss, four had premature, and two had full-term delivery; among the three pregnant women without HTGP, one had a premature and two had full-term births; five of thirteen (38.5%) births were neonatal asphyxia. Conclusion: Pregnant women with HTGP history, if not treated, are likely to develop the condition recurrently during pregnancy, but timely intervention on hypertriglyceridemia with lipid-lowering and thrombosis-preventing seemed complete to reduce the recurrent HTGP and improve the pregnancy outcomes.

Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Plasma Diafiltration

Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Plasma Diafiltration

Plasmapheresis Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis: A Case Report

Hypertriglyceridemia is the third most common etiology for acute pancreatitis (AP), after alcohol and gallstones. Clinical evidence is relatively weak in its support of plasmapheresis for the treatment of hypertriglyceridemia-induced acute pancreatitis (HTG-AP). We report a case of severe HTG-AP in a young man who was successfully treated with plasmapheresis. The patient achieved full resolution of symptoms within 48 hours from presentation and was discharged two days later. To our knowledge, no other report in literatures shows such dramatic response to plasmapheresis.

Are There Differences in the Management of Acute Pancreatitis Cases Due to Severe Hypertriglyceridemia in Pregnant Women?

BackgroundThe aim of this study was to determine the prognosis of severe disease and treatment approaches of both normal and pregnant, especially in patients with severe pancreatitis due to hypertriglyceridemia.Material/MethodsWe included 30 patients (20 females and 10 males) in this study whose follow-ups and treatments were performed after a diagnosis of hypertriglyceridemia-induced acute pancreatitis between January 2011 and May 2017. Patient personal information, such as age, sex, pre-treatment and post-treatment triglyceride levels, receipt of anti-hyperlipidemic treatments or plasmapheresis, and family history, were collected from hospital records and patient files. Patients with severe pancreatitis history, score, and prognosis were included to increase the value of our study. Mild and moderate cases were excluded.ResultsThe mean age of the patients was 35±6 years. Twenty-four patients (80%) received an anti-hyperlipidemic treatment before their pancreatitis attacks. Plasmapheresis was performed on 8 patients before their pancreatitis attacks. Eighteen patients (60%) had a family history suggesting familial hypertriglyceridemia. Twelve patients (40%) were pregnant.ConclusionsThe treatment of hypertriglyceridemia-induced acute pancreatitis was mostly confined to supportive, palliative treatments. However, plasmapheresis is a possible treatment option and should be used in the early stages of this disease. The response to medical treatment and support treatment was better in pregnant patients than in the other patient group, and pregnant patients did not require plasmapheresis.

Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Insulin, Heparin, and Gemfibrozil: A Case Series.

Hypertriglyceridemia is the third most common worldwide cause of acute pancreatitis. Resolving the underlying etiology is imperative for optimal management. This is especially true with regard to hypertriglyceridemia, as this etiology may cause more severe acute pancreatitis and worse symptoms than other causes of the disease. Many pharmacological treatment options for hypertriglyceridemia-induced acute pancreatitis (HTGP) have been proposed; however, the safety and efficacy for specific treatment regimens remain nebulous. At our institution, 6 patients, whose average Ranson criteria score were 5 and presenting triglyceride concentrations were 3501 mg/dL, were managed with a continuous infusion of insulin, subcutaneous heparin, and oral gemfibrozil for HTGP. Maximum insulin infusion rates ranged from 0.8 to 20.9 U/h. Half of the patients received nongemfibrozil cholesterol medication. Five patients experienced a resolution of HTGP (median day 3). The only adverse drug event was hypoglycemia in a single patient. Combination therapy with heparin, insulin, and gemfibrozil is safe and efficacious in quickly lowering serum triglyceride concentrations in HTGP. This combination warrants further study.

Clinical features and treatment of hypertriglyceridemia-induced acute pancreatitis during pregnancy: A retrospective study.

To analyze the features and treatment of hypertriglyceridemia-induced acute pancreatitis (HTGP) during pregnancy. A retrospective study of 21 pregnant women diagnosed with acute pancreatitis (AP) was performed. Patients were divided into acute biliary pancreatitis (ABP), HTGP, and idiopathic groups according to etiology. 95% of the patients were in the third trimester of gestation. The percentage of patients with HTGP was higher than that of ABP (48% vs.14%). The percentage of severe acute pancreatitis (SAP) in the HTGP group was higher than that in the ABP group (40.0% vs.0%). The Ranson scores for moderately severe acute pancreatitis (MSAP) and SAP in the HTGP group were significantly different (2.50 ± 0.58 vs.3.60 ± 0.89, P < 0.05, respectively). The mean serum triglyceride (TG) levels in the MSAP and SAP HTGP groups were not significantly different (18.81 ± 11.13 vs. 30.53 ± 24.20 mmol/L, P > 0.05, respectively). In the HTGP group, there were five patients given plasma exchange therapy and five not. Plasmapheresis decreased the incidence of systemic inflammatory response syndrome (SIRS) from 100% to 28.6% and the TG level from 20.36 ± 7.41 mmol/L to 5.23 ± 3.62 mmol/L (P < 0.05). The length of hospitalization of the plasmapheresis group was shorter than that of the nonplasmapheresis group (17.3 ± 6.7 days vs. 37.0 ± 20.8 days). Plasma exchange may be safe and effectively administered for HTGP patients during pregnancy with SIRS or multiple organ dysfunction syndrome (MODS). J. Clin. Apheresis 31:571-578, 2016. © 2015 Wiley Periodicals, Inc.

Treatment approach in our hypertriglyceridemia induced acute pancreatitis patients

Objectives: We aimed to research the superiority of insulin infusion and triglyceride apheresis for the treatment of hypertriglyceridemia-induced acute pancreatitis (HIAP). Patients and methods: In this retrospective, single-center cohort study, demographic data, clinical and biochemical parameters of HIAP were retrieved from the medical record database. The clinical data of 12 patients with HIAP were retrospectively analyzed. Results: The indication and timing of intervention and which treatment modality in HIAP is most efficacious remains unclear. We want to highlight our experience that seems to be equal therapeutic potential of both options. Conclusion: In treatment of HIAP, comorbidities should be taken into consideration and treatment should be personalized. More studies are needed to help define the best treatment option for HIAP.

Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin.

IntroductionHypertriglyceridaemia (HT)-induced pancreatitis rarely occurs unless triglyceride levels exceed 1000 mg/dl. Hypertriglyceridaemia over 1,000 mg/dl can provoke acute pancreatitis (AP) and its persistence can worsen the clinical outcome. In contrast, a rapid decrease in triglyceride level is beneficial. Insulin-stimulated lipoprotein lipase is known to decrease serum triglyceride levels. However, their efficacy in HT-induced AP is not well documented.AimTo present 12 cases of AP successfully treated by insulin administration.Material and methodsThree hundred and forty-three cases of AP were diagnosed at our clinic between 2005 and 2012. Twelve (3.5%) of these cases were HT-induced AP. Twelve patients who suffered HT-induced AP are reported. Initial blood triglyceride levels were above 1000 mg/dl. Besides the usual treatment of AP, insulin was administered intravenously in continuous infusion. The patients’ medical records were retrospectively evaluated in this study.ResultsSerum triglyceride levels decreased to < 500 mg/dl within 2–3 days. No complications of treatment were seen and good clinical outcome was observed.ConclusionsOur results are compatible with the literature. Insulin may be used safely and effectively in HT-induced AP therapy. Administration of insulin is efficient when used to reduce triglyceride levels in patients with HT-induced AP.

Hypertriglyceridemia Induced Pancreatitis – Treatment either with Heparin and Insulin or Conservative Management

The combination of heparin and insulin is a newer but not well-studied modality for the treatment of hypertriglyceridemia-induced acute pancreatitis. We report three patients of hypertriglyceridemia induced mild acute pancreatitis. Two patients had evidence of acute pancreatitis on abdominal CECT but their amylase and lipase levels were less than three times the upper limit of normal. Two patients were treated with heparin and insulin followed by fibrate, and the third was treated conservatively with fibrate only. The patients treated with insulin and heparin showed a rapid fall in triglyceride level (52%) on day one as compared to the patient treated conservatively (17.5%) with marked improvement in the pain score as assessed by the visual analogue scale. All the patients were maintained on fibrates to keep a level of triglycerides less than 200 mg/dL and were asymptomatic at 15, 27 and 40 months of follow-up.

Plasma Exchange (PE) as Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis (HTGAP)

Effective treatment of HTGAP is not clearly established. Immediate drop of TG level is needed which cannot be achieved with low fat diet, lipid lowering agents, pancreatic enzyme replacement and even with heparin and insulin. Although PE has been increasingly used to reduce TG levels during AP, data on its effectiveness is limited. We report 2 cases of HTGAP treated with PE resulting in favorable outcome. Pts 1 & 2 are 27 and 43 yr old females, both prior cholecystectomy admitted with epigastric pain, nausea and vomiting. CT scan showed enlarged edematous pancreas with peri-pancreatic fat stranding and fluid more severe in pt 2. Pancreatic necrosis was not seen. Lab tests are presented in Table 1. PE was performed on the 3rd hospital day on pt 1 and 4th day on pt 2 for nonresolving symptoms despite conventional treatment. 3L of plasma was exchanged with 3L 5% albumin and 210mL NS. Symptoms resolved in pt 1 after the 1st and pt 2 after the 3rd PE. Both pts were discharged in good clinical condition, to be followed in endocrine clinic for long term treatment of HTG. Decreased serum calcium and CT findings of fluid sequestration indicated severe AP in both pts. When conventional treatment failed, PE with TG removal resulted in symptom resolution. Large TG removal rates (83% pt 1, 88% pt 2) also led to decrease in lipase and amylase levels. Local tissue injury and local acidosis induced by fatty acids and TG lead to the release of pancreatic enzymes and subsequent autodigestion. With PE, TG and hence fatty acids are removed, along with cytokines and activated proteases in the plasma which are involved in the progression of inflammation of AP. No complications related to PE occurred in our pts. It was recommended that PE be performed within 48 hrs to avoid AP-related complications. PE should be considered as first-line treatment of HTGAP and should be applied as early as possible to prevent progression of inflammation and associated morbidity and mortality.Table 1: Laboratory Tests.

Heparin and Insulin in the Treatment of Hypertriglyceridemia-Induced Severe Acute Pancreatitis

Heparin and insulin stimulate lipoprotein lipase activity. Therefore, they reduce serum triglyceride levels. However, heparin and insulin's efficacy in treatment of hypertriglyceridemia-induced acute pancreatitis is not well established. We report a patient in whom heparin and insulin were used successfully.