1
|
Lin YF, Yao Y, Xu Y, Huang HB. Apheresis Technique for Acute Hyperlipidemic Pancreatitis: A Systemic Review and Meta-Analysis. Dig Dis Sci 2023; 68:948-956. [PMID: 35731426 DOI: 10.1007/s10620-022-07545-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/25/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND The apheresis technique is increasingly used in patients with hypertriglyceridemia-induced pancreatitis (HTGP), while its role in this context is still not well established. Thus, we aimed to evaluate the clinical outcomes of an apheresis therapy compared to usual care in such a patient population. METHODS We searched PubMed, Embase, and Cochrane library databases up to July 10, 2021. Studies were included if they focused on HTGP treated with or without apheresis technique. We used the Newcastle-Ottawa Scale to assess the quality of the included studies. The primary outcome was the mortality rate. We also explored the heterogeneity, sensitivity analysis, subgroup analysis, and publication bias. RESULTS Sixteen observational studies with 1476 adults were included. The overall quality of included studies was moderate. Despite better TG level reduction with apheresis therapy (mean difference [MD], 12.27 mmol/L, 95% CI, 3.74 to 20.81; I2 = 78%; P = 0.005), use of apheresis did not reduce the mortality (odds ratio [OR], 1.01; 95% CI, 0.65 to 1.59; P = 0.95) compared with usual care. This result was further confirmed by sensitivity analysis, subgroup analysis. The length of stay in hospital (MD, 0.96 days; 95% CI, - 1.22 to 3.14; I2 = 70%; P = 0.39) and most complications were similar between the groups, while hospital cost was significantly higher in the apheresis group. CONCLUSIONS The apheresis technique did not decrease the mortality in HTGP patients compared with usual care. Until the results of high-quality RCTs are known, these findings do not support the routine use of the apheresis technique in such a patient population.
Collapse
Affiliation(s)
- You-Fei Lin
- Department of Tuberculosis, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, No.2 Hubian, Cangshan District, Fuzhou, 350008, China
| | - Yan Yao
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Yuan Xu
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Hui-Bin Huang
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China.
| |
Collapse
|
2
|
Mercure-Corriveau N, O'Brien C, Garg A, Crowe EP, Bloch EM, Tobian AAR. Therapeutic plasma exchange for the treatment of extracorporeal membrane oxygenation dysfunction caused by hypertriglyceridemia. Transfusion 2022; 62:2427-2428. [PMID: 35975478 DOI: 10.1111/trf.17070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Nicolas Mercure-Corriveau
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Caitlin O'Brien
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anjali Garg
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth P Crowe
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Zhang GF, Yu XQ, Hu YP, Yang Q, Li WQ. Progress in research of acute pancreatitis in pregnancy. Shijie Huaren Xiaohua Zazhi 2022; 30:541-546. [DOI: 10.11569/wcjd.v30.i12.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis in pregnancy (APIP) is a rare and severe complication of pregnancy, which is characterized by rapid onset, rapid progression, many complications, and high mortality. According to previous studies, the incidence of APIP is about 1/10000-1/1000 and increases with gestational age. Due to the differences in genetic background and dietary habits between Asian and European populations, the incidence of APIP in China is as high as 1.14‰-2.27‰, significantly higher than that in Western countries. The lack of specific clinical symptoms of APIP often leads to misdiagnosis or missed diagnosis, which greatly increases the difficulty of diagnosis and treatment. Despite the deepening of the research on APIP, its pathogenesis is still unclear. This paper will give a systematical review of APIP.
Collapse
Affiliation(s)
- Guo-Fu Zhang
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Xian-Qiang Yu
- Medical College of Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Yue-Peng Hu
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Qi Yang
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Wei-Qin Li
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China,Medical College of Southeast University, Nanjing 210009, Jiangsu Province, China,Department of Critical Care Medicine, General Hospital of Eastern Theater Command, Nanjing 210002, Jiangsu Province, China
| |
Collapse
|
4
|
Ahmed SF, Qadir PH, Ahmed SM, Salih KM, Abdulla BA, Mohammed HR, Salih AM, Kakamad FH. Recurrent seasonal severe hypertriglyceridemia-induced acute pancreatitis; a case report. Ann Med Surg (Lond) 2022; 75:103406. [PMID: 35386772 PMCID: PMC8977940 DOI: 10.1016/j.amsu.2022.103406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Acute pancreatitis (AP) is a serious inflammatory condition of the pancreas. Hypertriglyceridemia (HTG) is considered an uncommon cause of AP. The current study aims to present a unique case of recurrent seasonal severe HTG-induced AP (HTG-AP); treated with insulin and heparin. Case report A 36-year-old male presented with recurrent attacks of severe upper abdominal pain that was radiating to the back and associated with repeated vomiting. The condition has being occurring every autumn-winter for the last three years. He had thalassemia minor and had a history of HTG-AP. His TG levels were relatively normal from February to August; however, from September to February, his TG levels highly elevated which has resulted in HTG-AP every year for the past three years. The condition was confirmed via a contrast-enhanced computerized tomography scan of the abdomen. To prevent the next HTG-AP, his TG level was monitored monthly. When TG levels spiked again, the patient was put on an insulin infusion with heparin, glucose, and potassium to rapidly reduce TG level. After two days, serum TG was dramatically reduced (<500 mg/dL). Discussion Despite multiple theories being proposed, the pathogenesis of HTG-AP is yet to be understood. Usually, HTG-AP is a single episodic, and recurrent HTG-AP is considered uncommon finding. Previous reports are contradictory regarding TG level and seasonal variation. There is currently no standard management approach to treat HTG-AP cases. Conclusion HTG-AP rarely reoccurs on an annual basis, and seasonal variation seems to play a major role in its onset. The condition can be managed with insulin, heparin, and glucose infusions. Hypertriglyceridemia is an uncommon cause of acute pancreatitis. Seasonal variation seems to play a role in the onset of recurrent hypertriglyceridemia-induced acute pancreatitis. It can be prevented and treated with insulin, heparin, and glucose infusions. This report aims to present a unique case of recurrent seasonal severe HTG-AP treated with insulin and heparin.
Collapse
Affiliation(s)
- Shaho F Ahmed
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Pshtiwan H Qadir
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Faruq Medical City, Malik Mahmud Ring Road, Sulaimani, Kurdistan, Iraq
| | - Sasan M Ahmed
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Karzan M Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Iraqi Board for Medical Specialties, General Surgery Department, Sulaimani Center, Sulaimani, Kurdistan, Iraq
| | - Berwn A Abdulla
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Hawbash R Mohammed
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.,Gaziosmanpasa University, Faculty of Medicine, Tokat, Turkey
| | - Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| |
Collapse
|
5
|
Chen Z, Huang X, Han N, Guo Y, Chen J, Ning Y, Zhang M. Total cholesterol concentration predicts the effect of plasmapheresis on hypertriglyceridemic acute pancreatitis: a retrospective case-control study. BMC Gastroenterol 2021; 21:3. [PMID: 33407166 PMCID: PMC7789165 DOI: 10.1186/s12876-020-01572-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/07/2020] [Indexed: 02/11/2023] Open
Abstract
Background What kind of patients with hypertriglyceridemic acute pancreatitis (HLAP) might benefit from plasmapheresis (PP) remains unknown. The objective of this study is to determine the predict function of total cholesterol (TC) on the Triglyceride (TG)-lowing effect in patients on either non-PP or PP therapy.
Methods Patients were categorized into high total cholesterol (HTC)/low total cholesterol (LTC) groups based on TC level of 12.4 mmol/L. The primary outcome was TG reduction to below 500 mg/dL within 48 h. Linear mixed-effect model and logistic regression analyses were used to assess the association of TC level and TG-lowing efficacy in different therapy groups. Results Compared with LTC group, patients with HTC showed more severe imaging manifestations (p < 0.001) and higher APACH II scores (p = 0.036). Deaths occurred only in HTC groups. Significant interaction of time sequence with the 2 TGs-lowing therapy groups on TG level was only found in HTC group (p < 0.001). In patients with elevated TC level, primary outcome occurred in 66.67% of patients in the PP group, and 27.91% in the non-PP group. After adjustment for age, gender, CT grade and APACH II score, the odd ratio remain significant (OR 5.47, 95% confidence interval [CI] 1.84–16.25, p = 0.002). Furthermore, in patients with lower TC level, no significant difference was found in primary outcome between PP group and non-PP group (81.25% versus 62.30%, adjusted OR 2.05; 95% CI 0.45–9.40; p = 0.353). Conclusions TC could be a potential biomarker to predict the effects of TG-lowing therapy in patients with HLAP.
Collapse
Affiliation(s)
- Zhu Chen
- Intensive Care Unit, The First Affiliated Hospital of Xiamen University, NO. 55, Zhenhai Road, Siming District, Xiamen City, Fujian, 361003, People's Republic of China
| | - Xiaolong Huang
- Intensive Care Unit, The First Affiliated Hospital of Xiamen University, NO. 55, Zhenhai Road, Siming District, Xiamen City, Fujian, 361003, People's Republic of China
| | - Na Han
- Xiamen Blood Center, NO. 121, Hubin South Road, Siming District, Xiamen City, Fujian, 361004, People's Republic of China
| | - Yanxia Guo
- Intensive Care Unit, The First Affiliated Hospital of Xiamen University, NO. 55, Zhenhai Road, Siming District, Xiamen City, Fujian, 361003, People's Republic of China
| | - Jing Chen
- Intensive Care Unit, The First Affiliated Hospital of Xiamen University, NO. 55, Zhenhai Road, Siming District, Xiamen City, Fujian, 361003, People's Republic of China
| | - Yaogui Ning
- Intensive Care Unit, The First Affiliated Hospital of Xiamen University, NO. 55, Zhenhai Road, Siming District, Xiamen City, Fujian, 361003, People's Republic of China
| | - Minwei Zhang
- Intensive Care Unit, The First Affiliated Hospital of Xiamen University, NO. 55, Zhenhai Road, Siming District, Xiamen City, Fujian, 361003, People's Republic of China.
| |
Collapse
|
6
|
Yu S, Yao D, Liang X, Jin K, Fu Y, Liu D, Zhang L, Yang J, Song X, Xu J, Yu X. Effects of different triglyceride-lowering therapies in patients with hypertriglyceridemia-induced acute pancreatitis. Exp Ther Med 2020; 19:2427-2432. [PMID: 32256719 PMCID: PMC7086183 DOI: 10.3892/etm.2020.8501] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/10/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of the present study was to investigate the effects of various triglyceride (TG)-lowering therapies on hypertriglyceridemia-induced acute pancreatitis (HTGAP). A total of 132 patients with HTGAP were retrospectively divided into an insulin intensive therapy (IIT), a plasma exchange (PE) and a non-intensive insulin therapy (NIIT) group according to the TG-lowering therapies they had received. The clinical and biochemical data of the subjects were analyzed. The baseline data, including sex, age, TG, amylase, severe acute pancreatitis and systemic inflammatory response syndrome were not significantly different among the three groups (P>0.05). The 24-h TG clearance rate (χ2=7.74, P=0.021), onset to treatment time (χ2=14.50, P<0.001) and the time required to reach the target TG level (χ2=6.12, P=0.047) were different in these three groups, but no significant differences were observed between the IIT and NIIT groups (P>0.05). The incidence of therapy-associated complications in the PE group (30.23%) was higher than that in the IIT (2.17%) and NIIT (4.65%) groups. The difference in the incidence of therapy-associated complications was significant among the three groups (P<0.001), but no significant difference was present between the IIT and NIIT groups (P>0.05). In the PE group, the length of stay was increased compared with that in the IIT and NIIT groups (χ2=7.05, P<0.05), while there was no significant difference between the IIT and NIIT groups (P>0.05). The present study suggested that NIIT at presentation had a similar therapeutic efficacy to that of IIT to improve the prognosis of HTGAP, and NIIT and IIT were associated with fewer complications than PE treatment. NIIT may favorably perform in patients presenting early after symptom onset and may be considered for clinical application.
Collapse
Affiliation(s)
- Shanshan Yu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Dongqi Yao
- Department of Emergency, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Xianquan Liang
- Department of Emergency, The Second People's Hospital of Guiyang, Guiyang, Guizhou 550023, P.R. China
| | - Kui Jin
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Yangyang Fu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Danyu Liu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Lili Zhang
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Jing Yang
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Xiao Song
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Jun Xu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Xuezhong Yu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| |
Collapse
|
7
|
Cruciat G, Nemeti G, Goidescu I, Anitan S, Florian A. Hypertriglyceridemia triggered acute pancreatitis in pregnancy - diagnostic approach, management and follow-up care. Lipids Health Dis 2020; 19:2. [PMID: 31901241 PMCID: PMC6942404 DOI: 10.1186/s12944-019-1180-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022] Open
Abstract
Acute pancreatitis is a pregnancy complication potentially lethal for both the mother and fetus, occurring most frequently in the third trimester or early postpartum. Hypertriglyceridemia may be the cause of important disease in pregnant patients. Patients with triglyceride levels exceeding 1000 mg/dL are at increased risk of developing severe pancreatitis. Diagnostic criteria and management protocols are not specific for pancreatitis complicating pregnancy. Other causes of acute abdominal pain must be considered in the differential diagnosis. Decision-making in the obstetric context is challenging and bears potential legal implications. Pre-pregnancy preventive measures and prenatal antilipemic treatment are mandatory in high risk patients.
Collapse
Affiliation(s)
- Gheorghe Cruciat
- Obstetrics and Gynecology, Mother and Child Department, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| | - Georgiana Nemeti
- Obstetrics and Gynecology, Mother and Child Department, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania.
| | - Iulian Goidescu
- Obstetrics and Gynecology, Mother and Child Department, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| | - Stefan Anitan
- Legal Medicine, Community Medicine Department, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| | - Andreea Florian
- Obstetrics and Gynecology, Mother and Child Department, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| |
Collapse
|
8
|
Berberich AJ, Ziada A, Zou GY, Hegele RA. Conservative management in hypertriglyceridemia-associated pancreatitis. J Intern Med 2019; 286:644-650. [PMID: 31077464 DOI: 10.1111/joim.12925] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Severe hypertriglyceridemia (serum triglyceride >10 mmol L-1 ) is implicated in ~9% of acute pancreatitis cases. Certain guidelines list severe hypertriglyceridemia as an indication for plasmapheresis. OBJECTIVE We assembled the natural trajectory of triglyceride levels in patients with acute pancreatitis due to severe hypertriglyceridemia who were managed conservatively without plasmapheresis to evaluate the effectiveness of this approach. METHODS A retrospective chart review was performed on 22 hospital admissions for acute pancreatitis episodes considered to be caused by severe hypertriglyceridemia. Patients were managed supportively, with cessation of oral intake (NPO) and intravenous hydration. Insulin infusion was used in 12 patients to manage concurrent hyperglycaemia. RESULTS Triglyceride levels for the group were evaluated using a mixed-effects model. The average triglyceride level fell from 45.4 mmol L-1 on presentation to 13.3 mmol L-1 within 48 h, corresponding to a mean 69.8% decrease. Regression analysis showed a triglyceride half-life of 30.6 h. Findings were similar for NPO-only and insulin infusion subgroups. CONCLUSION Patients with severe hypertriglyceridemia and acute pancreatitis can be conservatively managed safely and effectively without plasmapheresis.
Collapse
Affiliation(s)
- A J Berberich
- From the, Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - A Ziada
- From the, Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - G Y Zou
- From the, Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - R A Hegele
- From the, Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| |
Collapse
|
9
|
Joury A, Alshehri M, Mahendra A, Anteet M, Yousef MA, Khan AM. Therapeutic approaches in hypertriglyceridemia-induced acute pancreatitis: A literature review of available therapies and case series. J Clin Apher 2019; 35:131-137. [PMID: 31724761 DOI: 10.1002/jca.21763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/10/2019] [Accepted: 11/01/2019] [Indexed: 12/11/2022]
Abstract
Hypertriglyceridemia-induced acute pancreatitis (HGAP) is the third most common etiology of acute pancreatitis. HGAP can be attributed to genetic disturbances in triglyceride metabolism or multiple secondary causes. Here, we presented three cases for HGAP and explored different therapeutic approaches for treating HGAP. A case series of three patients who presented with HGAP and underwent different therapeutic approaches was conducted. The first patient was a 37-year-old male who presented with nonsevere HGAP; he was treated with conservative therapy with insulin and heparin infusion, which resulted in clinical and laboratory improvement. The second patient was a 64-year-old male with human immunodeficiency virus on multiple highly active antiretroviral therapy. He presented with severe HGAP and multiorgan failure. After initiation of therapeutic plasma exchange, his HGAP resolved. The third patient was a 28-year-old male who presented with recurrent episodes of HGAP; his conservative therapy failed and was eventually escalated to therapeutic plasma exchange (TPE). HGAP can be attributed to genetic disturbances of lipid or secondary etiologies. A nonsevere form of HGAP can be managed with conventional therapy including insulin and heparin; however, severe HGAP may require TPE.
Collapse
Affiliation(s)
- Abdulaziz Joury
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana.,King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mona Alshehri
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Arjun Mahendra
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Mahmoud Anteet
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Mohammad A Yousef
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Abdul M Khan
- Department of Pulmonary and Critical Care, Ochsner Clinic Foundation, New Orleans, Louisiana
| |
Collapse
|
10
|
Therapeutic plasma exchange in secondary prevention of acute pancreatitis in pregnant patient with familial hyperchylomicronemia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 163:90-94. [PMID: 30198520 DOI: 10.5507/bp.2018.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/06/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Hormone changes during pregnancy lead to increased plasma lipid levels. When there is added disorder of lipid metabolism, this otherwise physiological change can cause extremely high triglyceride levels with potentionally life-threatening complications, such as non-biliary acute pancreatitis. MATERIALS AND METHODS We present a case report of a 27-year-old pregnant woman with familial hyperchylomicronemia and a history of 7 hypertriglyceridemia-induced acute pancreatitis attacks. Three attacks occured during her first pregnancy with the last one leading to its termination at 33 weeks owing to the death of the fetus. During her second pregnancy, standard treatment was not able to lower the triglyceride levels sufficiently and she suffered another acute pancreatitis attack. Therapeutic plasma exchange was therefore chosen as the treatment method. RESULTS AND CONCLUSION Plasma exchange was succesful in the secondary prevention of acute pancreatitis attack and she delivered a healthy baby at 36 weeks of gestation. Treatment was very well tolerated by the mother and the fetus and this supports the use of apheresis as a safe and efficient method in tackling gestational hypertriglyceridemia.
Collapse
|
11
|
Epidemiology and Etiology of Acute Pancreatitis in Urban and Suburban Areas in Shanghai: A Retrospective Study. Gastroenterol Res Pract 2018; 2018:1420590. [PMID: 30158961 PMCID: PMC6109519 DOI: 10.1155/2018/1420590] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/14/2018] [Accepted: 05/24/2018] [Indexed: 01/30/2023] Open
Abstract
Aim To investigate the epidemiology, etiology, and severity of acute pancreatitis (AP) in urban and suburban areas of Shanghai in 2011 and 2016. Methods A retrospective study of patients admitted to Shanghai General Hospital (urban and suburban campuses) with AP in 2011 and 2016 was undertaken. Patients were divided into acute biliary pancreatitis (ABP), hypertriglyceridemic pancreatitis (HTGP), alcoholic pancreatitis, and pancreatitis of other causes according to etiology. Severity of AP was divided into mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP). Results AP patients in the suburban area increased more rapidly than those in the urban area. The mean onset age of AP in the urban area in 2016 was older than that in the suburban area (p < 0.05). The suburban patients in 2016 have significantly younger mean onset age than those in 2011 (p < 0.05). HTGP incidence in suburban patients increased from 2011 to 2016, which changed little in the urban area. Urban females were more likely to develop HTGP than suburban ones in 2011, which reversed in 2016. As to the male patients, the incidence of HTGP increased in both urban and suburban areas. Nonelderly (<60 years old) patients had higher HTGP incidence than elderly ones in both 2011 and 2016. The descending trend of SAP in the suburban area was more obvious than that in the urban area. The length of hospitalization decreased from 2011 to 2016, especially in SAP patients. Conclusions AP patients increased more rapidly in the suburban area of Shanghai with younger onset age. The incidence of HTGP increased significantly in the suburban area, reminding of the prevention and screening of HTG.
Collapse
|
12
|
Rivers E, Reynolds BC, Bunn S, Leech NJ, Straker J, Lambert HJ. Acute Pancreatitis Secondary to Severe Hypertriglyceridaemia in a Patient with Type 1a Glycogen Storage Disease: Emergent Use of Plasmapheresis. JIMD Rep 2017; 42:1-4. [DOI: 10.1007/8904_2017_64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 09/21/2017] [Accepted: 09/29/2017] [Indexed: 11/24/2022] Open
|
13
|
Huang C, Liu J, Lu Y, Fan J, Wang X, Liu J, Zhang W, Zeng Y. Clinical features and treatment of hypertriglyceridemia-induced acute pancreatitis during pregnancy: A retrospective study. J Clin Apher 2016; 31:571-578. [PMID: 26946248 DOI: 10.1002/jca.21453] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Chunlan Huang
- Department of Gastroenterology; Shanghai General Hospital, Shanghai Jiao Tong University; Shanghai 200080 China
| | - Jie Liu
- Department of Gastroenterology; Shanghai General Hospital, Shanghai Jiao Tong University; Shanghai 200080 China
- Department of Gastroenterology; Suzhou Science and Technology City Hospital; Suzhou City Jiangsu Province 215000 China
| | - Yingying Lu
- Department of Gastroenterology; Shanghai General Hospital, Shanghai Jiao Tong University; Shanghai 200080 China
| | - Junjie Fan
- Department of Gastroenterology; Shanghai General Hospital, Shanghai Jiao Tong University; Shanghai 200080 China
| | - Xingpeng Wang
- Department of Gastroenterology; Shanghai General Hospital, Shanghai Jiao Tong University; Shanghai 200080 China
| | - Jun Liu
- Department of Nephrology; Shanghai General Hospital, Shanghai Jiao Tong University; Shanghai 200080 China
| | - Wei Zhang
- Department of Gastroenterology; Huadong Hospital Affiliated to Fudan University; Shanghai 200040 China
| | - Yue Zeng
- Department of Gastroenterology; Shanghai General Hospital, Shanghai Jiao Tong University; Shanghai 200080 China
| |
Collapse
|
14
|
Charlesworth A, Steger A, Crook MA. Acute pancreatitis associated with severe hypertriglyceridaemia; A retrospective cohort study. Int J Surg 2015; 23:23-7. [PMID: 26391596 DOI: 10.1016/j.ijsu.2015.08.080] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 08/07/2015] [Accepted: 08/19/2015] [Indexed: 01/22/2023]
Abstract
AIM Acute Pancreatitis (AP) secondary to hypertriglyceridaemia (HTG) is a rare association of which little is known in the literature. This study investigates patient characteristics and outcomes (reoccurrence and mortality) in those presenting with AP secondary to HTG in one of the largest reported British cohorts. METHODS A retrospective observational case note review of all patients treated at our institution between 2004 and 2012. Data are expressed as mean and standard deviation if parametric and as median and range if non-parametric. Full fasting lipid profiles and patient demographics were recorded to elucidate further the cause of the severe hypertriglyceridaemia (>10 mmol/L fasting). RESULTS There were 784 patients admitted with AP admitted to our institution within the study period. APHTG was present in 18 patients (2.3%). Peak serum triglyceride concentration was 43.9 mmol/L, SD 18.9 mmol/L. Serum amylase activity was 'falsely' low (with raised urine amylase) in about 10% of the patients with acute pancreatitis and hypertriglyceridaemia. 67% of our patients had type 2 diabetes mellitus or impaired glucose tolerance, 28% had a fatty liver and 50% displayed alcohol excess all these conditions are known to be associated with HTG There was a 94.5% reduction in serum triglyceride between presentation and last follow-up visit. There were also no deaths or recurrent episodes of AP during the study period. CONCLUSIONS APHTG was present in 2.3% of patients presenting with AP. The reoccurrence and mortality rates were zero in this cohort. This may in part be due to aggressive serum triglyceride lowering by a multi-disciplinary team. Early clinical recognition is vital to provide targeted treatment and to try and reduce further episodes of AP.
Collapse
Affiliation(s)
- Annika Charlesworth
- Dept of Gastroenterology, University Hospital Lewisham, Lewisham, London, SE13 6LH, United Kingdom
| | - Adrian Steger
- Dept of Surgery, University Hospital Lewisham, Lewisham, London, SE13 6LH, United Kingdom
| | - Martin A Crook
- Department of Clinical Biochemistry, University Hospital Lewisham, Lewisham, London, SE13 6LH, United Kingdom.
| |
Collapse
|
15
|
Seth A, Rajpal S, Saigal T, Bienvenu J, Sheth A, Alexander JS, Boktor M, Manas K, Morris JD, Jordan PA. Diabetic Ketoacidosis-induced Hypertriglyceridemic Acute Pancreatitis Treated with Plasmapheresis-Recipe for Biochemical Disaster Management. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2014; 7:51-3. [PMID: 25342924 PMCID: PMC4206354 DOI: 10.4137/cgast.s18557] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 08/28/2014] [Accepted: 08/31/2014] [Indexed: 12/18/2022]
Abstract
Diabetic ketoacidosis (DKA)-induced hypertriglyceridemia causing pancreatitis is an interesting phenomenon that has rarely been reported in literature. Plasmapharesis is a well known treatment modality for hypertriglyceridemia-induced pancreatitis. We report a patient with DKA-induced hypertriglyceridemic acute pancreatitis treated successfully with plasmapharesis.
Collapse
Affiliation(s)
- Abhishek Seth
- Department of Medicine, Section of Gastroenterology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Saurabh Rajpal
- Department of Medicine, Section of Gastroenterology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Taru Saigal
- Department of Medicine, Section of Gastroenterology, LSU Health Sciences Center, Shreveport, LA, USA
| | - John Bienvenu
- Department of Medicine, Section of Gastroenterology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Ankur Sheth
- Department of Medicine, Section of Gastroenterology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Jonathan S Alexander
- Department of Medicine, Section of Gastroenterology, LSU Health Sciences Center, Shreveport, LA, USA. ; Department of Molecular and Cellular Physiology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Moheb Boktor
- Department of Medicine, Section of Gastroenterology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Kenneth Manas
- Department of Medicine, Section of Gastroenterology, LSU Health Sciences Center, Shreveport, LA, USA
| | - James D Morris
- Department of Medicine, Section of Gastroenterology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Paul A Jordan
- Department of Medicine, Section of Gastroenterology, LSU Health Sciences Center, Shreveport, LA, USA
| |
Collapse
|
16
|
Markota A, Knehtl M, Sinkovic A, Ekart R, Hojs R, Bevc S. Plasma exchange treatment for acute hyperlipidemic pancreatitis with falsely low levels of serum triglycerides – a case report. Transfus Apher Sci 2014; 51:178-80. [DOI: 10.1016/j.transci.2014.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/19/2014] [Indexed: 12/18/2022]
|
17
|
Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med 2014; 25:689-94. [PMID: 25269432 DOI: 10.1016/j.ejim.2014.08.008] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 12/21/2022]
Abstract
Severe hypertriglyceridemia (HTG) is a well established and the most common cause of acute pancreatitis (AP) after alcohol and gall stone disease. It is alleged to account for up to 10% of all pancreatitis episodes. Studies suggest that in patients with triglyceride (TG) levels>1000 mg/dL (>11.3 mmol/L), hypertriglyceridemia-induced acute pancreatitis (HTGP-AP) occurs in approximately 15-20% of all subjects referred to Lipid Clinics. Until now, there is no clear evidence which patients with severe HTG will develop pancreatitis and which will not. Underlying pathophysiological concepts include hydrolysis of TG by pancreatic lipase and excessive formation of free fatty acids with inflammatory changes and capillary injury. Additionally hyperviscosity and ischemia may play a decisive role. The clinical features of HTG-AP patients are supposed to be no different from patients with AP of other etiologies. Yet, there are well-conducted studies suggesting that HTG-AP is associated with a higher severity and complication rate. Therapeutic measurements in HTG-AP include dietary modifications, different antihyperlipidemic agents, insulin and/or heparin treatment. The beneficial use of plasmapheresis is repeatedly reported and suggested in many studies. Yet, due to the lack of randomized and controlled trials, it is currently unknown if plasmapheresis may improve morbidity and mortality in the clinical setting of HTG-AP. Since there are no commonly accepted clinical guidelines in the management of HTG-AP, there is a definite need for an international, multicenter approach to this important subject.
Collapse
Affiliation(s)
- Pedro Valdivielso
- Department of Medicine and Dermatology, University of Malaga, Spain; Servicio de Medicina Interna, Hospital Virgen de la Victoria, Malaga, Spain
| | - Alba Ramírez-Bueno
- Servicio de Medicina Interna, Hospital Virgen de la Victoria, Malaga, Spain
| | - Nils Ewald
- Justus-Liebig-University Giessen, 35392 Giessen, Germany; General Hospital Luebbecke-Rahden, Department of Internal Medicine, 32312 Luebbecke, Germany.
| |
Collapse
|
18
|
Stefanutti C, Labbadia G, Morozzi C. Severe hypertriglyceridemia-related acute pancreatitis. Ther Apher Dial 2013; 17:130-7. [PMID: 23551669 DOI: 10.1111/1744-9987.12008] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Acute pancreatitis is a potentially life-threatening complication of severe hypertriglyceridemia. In some cases, inborn errors of metabolism such as lipoprotein lipase deficiency, apoprotein C-II deficiency, and familial hypertriglyceridemia have been reported as causes of severe hypertriglyceridemia. More often, severe hypertriglyceridemia describes various clinical conditions characterized by high plasma levels of triglycerides (>1000 mg/dL), chylomicron remnants, or intermediate density lipoprotein like particles, and/or chylomicrons. International guidelines on the management of acute pancreatitis are currently available. Standard therapeutic measures are based on the use of lipid-lowering agents (fenofibrate, gemfibrozil, niacin, Ω-3 fatty acids), low molecular weight heparin, and insulin in diabetic patients. However, when standard medical therapies have failed, non-pharmacological approaches based upon the removal of triglycerides with therapeutic plasma exchange can also provide benefit to patients with severe hypertriglyceridemia and acute pancreatitis. Plasma exchange could be very helpful in reducing triglycerides levels during the acute phase of hyperlipidemic pancreatitis, and in the prevention of recurrence. The current evidence on management of acute pancreatitis and severe hypertriglyceridemia, focusing on symptoms, treatment and potential complications is reviewed herein.
Collapse
Affiliation(s)
- Claudia Stefanutti
- Department of Immunohematology and Transfusion Medicine,, Extracorporeal Therapeutic Techniques Unit, Rome, Italy.
| | | | | |
Collapse
|
19
|
Abstract
Environmental and lifestyle changes have led to an increasing incidence of primary or secondary high triglycerides. As elevated triglycerides are an important risk factor for acute pancreatitis (AP), the incidence of AP of this cause has also been gradually increasing. Patients with hyperlipidemic AP often suffer severely and develop more complications. Crucial therapy is to lower serum triglyceride levels. In this article, we will summarize the recent progress in the treatment of hyperlipidemic pancreatitis.
Collapse
|
20
|
Acute pancreatitis secondary to gestational hypertriglyceridaemia. Case Rep Med 2012; 2012:627890. [PMID: 22844296 PMCID: PMC3400369 DOI: 10.1155/2012/627890] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 06/11/2012] [Accepted: 06/14/2012] [Indexed: 12/18/2022] Open
Abstract
Gestational hypertriglyceridaemia is a rare cause of acute pancreatitis. Its pathophysiology is incompletely understood. Severity scoring and effective management remain challenging. We report a case of acute pancreatitis secondary to gestational hypertriglyceridaemia. We describe the use of computed tomography to provide an alternative determination of severity, as well as plasmapheresis as a means of treating the condition.
Collapse
|
21
|
Kostapanos MS, Elisaf MS, Mikhailidis DP. Hypertriglyceridemia-induced acute pancreatitis: clinical considerations. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/clp.12.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
22
|
Kella DK, Shoukat S, Sperling L. Plasma exchange for severe hypertriglyceridemia-induced pancreatitis in an orthotopic heart transplant recipient. J Clin Lipidol 2012; 6:474-6. [PMID: 23009784 DOI: 10.1016/j.jacl.2012.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 12/18/2011] [Accepted: 01/18/2012] [Indexed: 12/21/2022]
Abstract
We here report a 33-year old male with diabetes, hypertension and history of orthotopic heart transplantation treated by plasma exchange for severe HTG (hypertriglyceridemia) induced pancreatitis. At the time of presentation, his serum TG (triglyceride) level was 10,278 mg/dL. He underwent one of the three planned sessions of plasma exchange, resulting in a decrease in TG level from 4728 mg/dL to 1708 mg/dL. The hospital course was complicated with shock, hemorrhagic transformation of the pancreatitis and acute respiratory distress syndrome. This prevented any further plasma exchange sessions. He was subsequently discharged home in a stable state and TG level of 80 mg/dL. Plasma exchange can be safely used to manage HTG induced pancreatitis in heart transplant recipients.
Collapse
Affiliation(s)
- Danesh K Kella
- Emory University School of Medicine, 1365 Clifton Road, NE Building A, Suite 2200, Atlanta, GA 30322, USA
| | | | | |
Collapse
|