Comparable Triglyceride Reduction With Plasma Exchange and Insulin in Acute Pancreatitis – A Randomized Trial
Background and AimsBoth insulin and plasma exchange (PE) are used in hypertriglyceridemic acute pancreatitis (HTG-AP). Our aim was to compare the efficacy of both treatments.MethodsA randomized, parallel group study performed in a tertiary hospital in 22 HTG-AP patients with non-severe prognosis and...
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.870067/full |
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| author | Jakob Gubensek Jakob Gubensek Milena Andonova Milena Andonova Alexander Jerman Vanja Persic Vanja Persic Barbara Vajdic-Trampuz Barbara Vajdic-Trampuz Ana Zupunski-Cede Ana Zupunski-Cede Nejc Sever Samo Plut Samo Plut |
| author_facet | Jakob Gubensek Jakob Gubensek Milena Andonova Milena Andonova Alexander Jerman Vanja Persic Vanja Persic Barbara Vajdic-Trampuz Barbara Vajdic-Trampuz Ana Zupunski-Cede Ana Zupunski-Cede Nejc Sever Samo Plut Samo Plut |
| author_sort | Jakob Gubensek |
| collection | DOAJ |
| description | Background and AimsBoth insulin and plasma exchange (PE) are used in hypertriglyceridemic acute pancreatitis (HTG-AP). Our aim was to compare the efficacy of both treatments.MethodsA randomized, parallel group study performed in a tertiary hospital in 22 HTG-AP patients with non-severe prognosis and triglycerides between 15 and 40 mmol/L. Patients were randomized to daily PE or insulin infusion until triglycerides were <10 mmol/L. Primary outcome was % reduction in triglycerides within 24 h. Secondary outcomes were days needed to lower triglycerides <10 mmol/L, highest CRP and percentage of patients with a severe course of pancreatitis.ResultsThere was a trend toward a greater decrease in triglycerides within the first 24 h in the PE group (67 ± 17% vs. 53 ± 17%, p = 0.07), but the absolute difference was modest [mean difference of 6 mmol/L (14% of initial value)]. Triglycerides fell below 10 mmol/L in a median (IQR) of 1 (1–2) and 2 (1–2) days, respectively (p = 0.25). Secondary outcomes related to disease severity were also comparable: highest CRP 229 vs. 211 mg/L (p = 0.69) and severe course of pancreatitis in 2/11 cases in both groups (p = 1.0). Regarding treatment complications, there was one mild hypoglycemia and one allergic reaction during PE. Survival was 100% in both groups.ConclusionThere was no significant difference, but only a trend toward a greater decrease in triglycerides with PE, and the clinical course was also comparable. These results do not support universal use of PE in patients with HTG-AP.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT02622854]. |
| first_indexed | 2024-12-21T14:27:48Z |
| format | Article |
| id | doaj.art-88e18e47c0df40d4879e3d6ecca32da6 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-21T14:27:48Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-88e18e47c0df40d4879e3d6ecca32da62022-12-21T19:00:35ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-04-01910.3389/fmed.2022.870067870067Comparable Triglyceride Reduction With Plasma Exchange and Insulin in Acute Pancreatitis – A Randomized TrialJakob Gubensek0Jakob Gubensek1Milena Andonova2Milena Andonova3Alexander Jerman4Vanja Persic5Vanja Persic6Barbara Vajdic-Trampuz7Barbara Vajdic-Trampuz8Ana Zupunski-Cede9Ana Zupunski-Cede10Nejc Sever11Samo Plut12Samo Plut13Department of Nephrology, University Medical Center Ljubljana, Ljubljana, SloveniaFaculty of Medicine, University of Ljubljana, Ljubljana, SloveniaDepartment of Nephrology, University Medical Center Ljubljana, Ljubljana, SloveniaFaculty of Medicine, University of Ljubljana, Ljubljana, SloveniaDepartment of Nephrology, University Medical Center Ljubljana, Ljubljana, SloveniaDepartment of Nephrology, University Medical Center Ljubljana, Ljubljana, SloveniaFaculty of Medicine, University of Ljubljana, Ljubljana, SloveniaDepartment of Nephrology, University Medical Center Ljubljana, Ljubljana, SloveniaFaculty of Medicine, University of Ljubljana, Ljubljana, SloveniaDepartment of Nephrology, University Medical Center Ljubljana, Ljubljana, SloveniaFaculty of Medicine, University of Ljubljana, Ljubljana, SloveniaDepartment of Gastroenterology, University Medical Center Ljubljana, Ljubljana, SloveniaFaculty of Medicine, University of Ljubljana, Ljubljana, SloveniaDepartment of Gastroenterology, University Medical Center Ljubljana, Ljubljana, SloveniaBackground and AimsBoth insulin and plasma exchange (PE) are used in hypertriglyceridemic acute pancreatitis (HTG-AP). Our aim was to compare the efficacy of both treatments.MethodsA randomized, parallel group study performed in a tertiary hospital in 22 HTG-AP patients with non-severe prognosis and triglycerides between 15 and 40 mmol/L. Patients were randomized to daily PE or insulin infusion until triglycerides were <10 mmol/L. Primary outcome was % reduction in triglycerides within 24 h. Secondary outcomes were days needed to lower triglycerides <10 mmol/L, highest CRP and percentage of patients with a severe course of pancreatitis.ResultsThere was a trend toward a greater decrease in triglycerides within the first 24 h in the PE group (67 ± 17% vs. 53 ± 17%, p = 0.07), but the absolute difference was modest [mean difference of 6 mmol/L (14% of initial value)]. Triglycerides fell below 10 mmol/L in a median (IQR) of 1 (1–2) and 2 (1–2) days, respectively (p = 0.25). Secondary outcomes related to disease severity were also comparable: highest CRP 229 vs. 211 mg/L (p = 0.69) and severe course of pancreatitis in 2/11 cases in both groups (p = 1.0). Regarding treatment complications, there was one mild hypoglycemia and one allergic reaction during PE. Survival was 100% in both groups.ConclusionThere was no significant difference, but only a trend toward a greater decrease in triglycerides with PE, and the clinical course was also comparable. These results do not support universal use of PE in patients with HTG-AP.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT02622854].https://www.frontiersin.org/articles/10.3389/fmed.2022.870067/fullacute hypertriglyceridemic pancreatitishypertriglyceridemiaapheresis – therapeuticconservative treatmentfree fatty acids |
| spellingShingle | Jakob Gubensek Jakob Gubensek Milena Andonova Milena Andonova Alexander Jerman Vanja Persic Vanja Persic Barbara Vajdic-Trampuz Barbara Vajdic-Trampuz Ana Zupunski-Cede Ana Zupunski-Cede Nejc Sever Samo Plut Samo Plut Comparable Triglyceride Reduction With Plasma Exchange and Insulin in Acute Pancreatitis – A Randomized Trial Frontiers in Medicine acute hypertriglyceridemic pancreatitis hypertriglyceridemia apheresis – therapeutic conservative treatment free fatty acids |
| title | Comparable Triglyceride Reduction With Plasma Exchange and Insulin in Acute Pancreatitis – A Randomized Trial |
| title_full | Comparable Triglyceride Reduction With Plasma Exchange and Insulin in Acute Pancreatitis – A Randomized Trial |
| title_fullStr | Comparable Triglyceride Reduction With Plasma Exchange and Insulin in Acute Pancreatitis – A Randomized Trial |
| title_full_unstemmed | Comparable Triglyceride Reduction With Plasma Exchange and Insulin in Acute Pancreatitis – A Randomized Trial |
| title_short | Comparable Triglyceride Reduction With Plasma Exchange and Insulin in Acute Pancreatitis – A Randomized Trial |
| title_sort | comparable triglyceride reduction with plasma exchange and insulin in acute pancreatitis a randomized trial |
| topic | acute hypertriglyceridemic pancreatitis hypertriglyceridemia apheresis – therapeutic conservative treatment free fatty acids |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.870067/full |
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