AUTHOR=Gubensek Jakob , Andonova Milena , Jerman Alexander , Persic Vanja , Vajdic-Trampuz Barbara , Zupunski-Cede Ana , Sever Nejc , Plut Samo 

TITLE=Comparable Triglyceride Reduction With Plasma Exchange and Insulin in Acute Pancreatitis – A Randomized Trial

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.870067

DOI=10.3389/fmed.2022.870067

ISSN=2296-858X

ABSTRACT=<sec><title>Background and Aims</title><p>Both insulin and plasma exchange (PE) are used in hypertriglyceridemic acute pancreatitis (HTG-AP). Our aim was to compare the efficacy of both treatments.</p></sec><sec><title>Methods</title><p>A 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 &lt;10 mmol/L. Primary outcome was % reduction in triglycerides within 24 h. Secondary outcomes were days needed to lower triglycerides &lt;10 mmol/L, highest CRP and percentage of patients with a severe course of pancreatitis.</p></sec><sec><title>Results</title><p>There was a trend toward a greater decrease in triglycerides within the first 24 h in the PE group (67 ± 17% vs. 53 ± 17%, <italic>p</italic> = 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 (<italic>p</italic> = 0.25). Secondary outcomes related to disease severity were also comparable: highest CRP 229 vs. 211 mg/L (<italic>p</italic> = 0.69) and severe course of pancreatitis in 2/11 cases in both groups (<italic>p</italic> = 1.0). Regarding treatment complications, there was one mild hypoglycemia and one allergic reaction during PE. Survival was 100% in both groups.</p></sec><sec><title>Conclusion</title><p>There 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.</p></sec><sec><title>Clinical Trial Registration</title><p>[<ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>], identifier [NCT02622854].</p></sec>