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Bashir B, Ferdousi M, Durrington P, Soran H. Pancreatic and cardiometabolic complications of severe hypertriglyceridaemia. Curr Opin Lipidol 2024; 35:208-218. [PMID: 38841827 PMCID: PMC11224574 DOI: 10.1097/mol.0000000000000939] [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] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW This review endeavours to explore the aetiopathogenesis and impact of severe hypertriglyceridemia (SHTG) and chylomicronaemia on cardiovascular, and pancreatic complications and summarizes the novel pharmacological options for management. RECENT FINDINGS SHTG, although rare, presents significant diagnostic and therapeutic challenges. Familial chylomicronaemia syndrome (FCS), is the rare monogenic form of SHTG, associated with increased acute pancreatitis (AP) risk, whereas relatively common multifactorial chylomicronaemia syndrome (MCS) leans more towards cardiovascular complications. Despite the introduction and validation of the FCS Score, FCS continues to be underdiagnosed and diagnosis is often delayed. Longitudinal data on disease progression remains scant. SHTG-induced AP remains a life-threatening concern, with conservative treatment as the cornerstone while blood purification techniques offer limited additional benefit. Conventional lipid-lowering medications exhibit minimal efficacy, underscoring the growing interest in novel therapeutic avenues, that is, antisense oligonucleotides (ASO) and short interfering RNA (siRNA) targeting apolipoprotein C3 (ApoC3) and angiopoietin-like protein 3 and/or 8 (ANGPTL3/8). SUMMARY Despite advancements in understanding the genetic basis and pathogenesis of SHTG, diagnostic and therapeutic challenges persist. The rarity of FCS and the heterogenous phenotype of MCS underscore the need for the development of predictive models for complications and tailored personalized treatment strategies. The establishment of national and international registries is advocated to augment disease comprehension and identify high-risk individuals.
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Affiliation(s)
- Bilal Bashir
- Faculty of Biology, Medicine and Health, University of Manchester
- Department of Endocrinology, Diabetes and Metabolism, Peter Mount Building, Manchester University NHS Foundation Trust
- NIHR/WELLCOME Trust Clinical Research Facility, Manchester, UK
| | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester
- NIHR/WELLCOME Trust Clinical Research Facility, Manchester, UK
| | - Paul Durrington
- Faculty of Biology, Medicine and Health, University of Manchester
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester
- Department of Endocrinology, Diabetes and Metabolism, Peter Mount Building, Manchester University NHS Foundation Trust
- NIHR/WELLCOME Trust Clinical Research Facility, Manchester, UK
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Liu Q, Gu X, Liu X, Gu Y, Zhang H, Yang J, Huang Z. Long-chain fatty acids - The turning point between 'mild' and 'severe' acute pancreatitis. Heliyon 2024; 10:e31296. [PMID: 38828311 PMCID: PMC11140623 DOI: 10.1016/j.heliyon.2024.e31296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
Acute pancreatitis (AP) is an inflammatory disease characterized by localized pancreatic injury and a systemic inflammatory response. Fatty acids (FAs), produced during the breakdown of triglycerides (TGs) in blood and peripancreatic fat, escalate local pancreatic inflammation to a systemic level by damaging pancreatic acinar cells (PACs) and triggering M1 macrophage polarization. This paper provides a comprehensive analysis of lipases' roles in the onset and progression of AP, as well as the effects of long-chain fatty acids (LCFAs) on the function of pancreatic acinar cells (PACs). Abnormalities in the function of PACs include Ca2+ overload, premature trypsinogen activation, protein kinase C (PKC) expression, endoplasmic reticulum (ER) stress, and mitochondrial and autophagic dysfunction. The study highlights the contribution of long-chain saturated fatty acids (LC-SFAs), especially palmitic acid (PA), to M1 macrophage polarization through the activation of the NLRP3 inflammasome and the NF-κB pathway. Furthermore, we investigated lipid lowering therapy for AP. This review establishes a theoretical foundation for pro-inflammatory mechanisms associated with FAs in AP and facilitating drug development.
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Affiliation(s)
- Qiang Liu
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310058, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310058, China
- Hangzhou Hospital & Institute of Digestive Diseases, Hangzhou, Zhejiang 310006, China
| | - Xinyi Gu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
| | - Xiaodie Liu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
| | - Ye Gu
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310058, China
| | - Hongchen Zhang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310058, China
| | - Jianfeng Yang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310058, China
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310058, China
- Hangzhou Hospital & Institute of Digestive Diseases, Hangzhou, Zhejiang 310006, China
| | - Zhicheng Huang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310058, China
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
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3
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Hussein EA. Factors affecting clinical outcomes of continuous and intermittent plasmapheresis in patients with severe hypertriglyceridemia. Ther Apher Dial 2024. [PMID: 38676441 DOI: 10.1111/1744-9987.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/08/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Acute hypertriglyceridemia is considered a category III indication for plasmapheresis. The use of plasma as replacement fluid (RF) has been suggested to replace the consumed lipoprotein lipase. Heparin when used as an anticoagulant could possibly release lipoprotein lipase, thereby increasing triglyceride clearance. METHODS The impact of RF (albumin vs fresh frozen plasma (FFP) and anticoagulant (ACD-A vs. heparin) on triglycerides following plasmapheresis in 27 patients with severe hypertriglyceridemia (SHTG) was investigated. A paired study of four patients with recurrent SHTG was conducted, evaluating continuous (Optia) versus intermittent flow plasmapheresis (Haemonetics). RESULTS Shorter procedures positively impacted triglycerides (TG) drop post-sessions p < 0.05. In albumin sessions, patients who used heparin demonstrated significantly greater drop in TG and required less sessions than did those with citrate p < 0.05. In heparin sessions, patients who used albumin demonstrated significantly greater drop in triglycerides and required less sessions than did those with FFP p < 0.05. Three of six patients who used FFP and heparin showed a triglyceride drop of 11.7% following three sessions and a 50% drop with one albumin session. Compared with Haemonetics, Optia removed comparable volumes of plasma in less time, processing smaller blood volumes and using less citrate p < 0.05. Patients demonstrated significantly lower drop in TG and required more sessions with Haemonetics than they did with Optia p < 0.05. CONCLUSION Shorter procedure was the main predictor for effective TG clearance. This can be achieved by continuous apheresis technology, particularly when using albumin as RF. TG removal via Optia seems to be optimized by using heparin.
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Affiliation(s)
- Eiman A Hussein
- Department of Clinical and Chemical Pathology, Division of Transfusion Medicine, Apheresis unit of Kasr Alainy Blood Bank, Faculty of Medicine, Cairo University, Cairo, Egypt
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Wang L, Zhou J, Lv C, Hong D, Wang Z, Mao W, Liu Y, Zhang Z, Li Y, Li G, Ye B, Li B, Cao L, Tong Z, Li W, Ke L. Impact of therapeutic plasmapheresis on the duration of organ failure in patients with hypertriglyceridemia-associated acute pancreatitis. Ann Intensive Care 2024; 14:57. [PMID: 38619686 PMCID: PMC11018571 DOI: 10.1186/s13613-024-01285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/29/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Plasmapheresis is widely used for severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP) to remove excessive triglycerides from plasma. This study aimed to evaluate whether plasmapheresis could improve the duration of organ failure in HTG-AP patients. METHODS We analyzed a cohort of patients from a multicenter, prospective, long-running registry (the PERFORM) collecting HTG-AP patients admitted to the study sites within 72 h from the onset of symptoms. This study was based on data collected from November 2020 to March 2023. Patients who had organ failure at enrollment were involved in the analyses. The primary outcome was time to organ failure resolution within 14 days. Multivariable Cox regression model was used to evaluate the association between plasmapheresis and time to organ failure resolution. Directed acyclic graph (DAG) was used to identify potential confounders. RESULTS A total of 122 HTG-AP patients were included (median [IQR] sequential organ failure assessment (SOFA) score at enrollment, 3.00 [2.00-4.00]). Among the study patients, 46 underwent plasmapheresis, and 76 received medical treatment. The DAG revealed that baseline serum triglyceride, APACHE II score, respiratory failure, cardiovascular failure, and renal failure were potential confounders. After adjusting for the selected confounders, there was no significant difference in time to organ failure resolution between patients undergoing plasmapheresis and those receiving exclusive medical treatment (HR = 1.07; 95%CI 0.68-1.68; P = 0.777). Moreover, the use of plasmapheresis was associated with higher ICU requirements (97.8% [45/46] vs. 65.8% [50/76]; OR, 19.33; 95%CI 2.20 to 169.81; P = 0.008). CONCLUSIONS In HTG-AP patients with early organ failure, plasmapheresis was not associated with accelerated organ failure resolution compared to medical treatment but may be associated with more ICU admissions. TRIAL REGISTRATION The PERFORM study was registered in the Chinese Clinical Trial Registry (ChiCTR2000039541). Registered 30 October 2020.
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Affiliation(s)
- Lanting Wang
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
- Research Institute of Critical Care Medicine and Emergency Rescue at Nanjing University, Nanjing, China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Cheng Lv
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Donghuang Hong
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Zuozheng Wang
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Wenjian Mao
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Yuxiu Liu
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zixiong Zhang
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Yuanzhen Li
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Gang Li
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Bo Ye
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Baiqiang Li
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Longxiang Cao
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China.
- Research Institute of Critical Care Medicine and Emergency Rescue at Nanjing University, Nanjing, China.
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
- Research Institute of Critical Care Medicine and Emergency Rescue at Nanjing University, Nanjing, China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
- Research Institute of Critical Care Medicine and Emergency Rescue at Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China.
- Research Institute of Critical Care Medicine and Emergency Rescue at Nanjing University, Nanjing, China.
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.
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5
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Piplani S, Jain A, Singh K, Gulati S, Chaturvedi S, Bejugam VR, Brown D, Asuzu C, Kolli ST, Shah U, Reet J, Mihajlovic M, Jelic V, Jelic G, Roberts RSD, Damania D, Radulovic M. Efficacy and adverse effects of insulin versus plasmapheresis in patients with hypertriglyceridemia-3-induced acute pancreatitis: a systematic review and meta-analysis. Ann Gastroenterol 2024; 37:109-116. [PMID: 38223249 PMCID: PMC10785016 DOI: 10.20524/aog.2023.0849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/03/2023] [Indexed: 01/16/2024] Open
Abstract
Background Hypertriglyceridemia is a common cause of acute pancreatitis (AP). This literature review compared the effectiveness and adverse events of insulin therapy, with or without heparin, and plasmapheresis, in reducing triglyceride levels in patients with hypertriglyceridemia-induced AP. Methods Systematic reviews, meta-analyses, evidence syntheses, editorials, commentaries, protocols, abstracts, theses and preprints were excluded. Review Manager was used to conduct the meta-analysis. The literature search yielded 2765 articles, but only 5 were included in the systematic review and meta-analysis and the total number of participants in the review was 269. Results From this study's analysis, insulin ± heparin was more successful in reducing triglyceride levels than plasmapheresis (standardized mean difference -0.37, 95% confidence interval [CI] 0.99 to 0.25; P=0.25). Insulin ± heparin therapy had a lower mortality rate than plasmapheresis (risk ratio [RR] 0.70, 95%CI 0.25-1.95). Hypotension, hypoglycemia, and acute renal failure were less common in the plasmapheresis therapy group than in insulin ± heparin therapy (RR 1.13, 95%CI 0.46-2.81, RR 3.90, 95%CI 0.45-33.78, and RR 0.48, 95%CI 0.02-13.98 for hypotension, hypoglycemia, and acute renal failure, respectively). Conclusions This study found no significant difference in mortality between insulin ± heparin therapy and plasmapheresis used for the reduction in triglyceride levels. It is notable that no substantial differences were observed in the most common side-effects encountered during these therapies, thus indicating non-inferiority.
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Affiliation(s)
- Shobhit Piplani
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Arpit Jain
- Department of Emergency Medicine, All India Institute of Medical Sciences, Delhi, India (Shobhit Arpit Jain)
| | - Kamaldeep Singh
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India (Kamaldeep Singh)
| | - Shreya Gulati
- Department of Internal Medicine, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India (Shreya Gulati)
| | - Salil Chaturvedi
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Vishal Reddy Bejugam
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Donclair Brown
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Chisom Asuzu
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Shiny Teja Kolli
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Usman Shah
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Jashan Reet
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Milos Mihajlovic
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Vladimir Jelic
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Gavro Jelic
- Department of Internal Medicine, James J. Peters VA Medical Center, Icahn School of Medicine, Bronx, NY, USA (Gavro Jelic, Miroslav Radulovic)
| | - Rosalba Santana De Roberts
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Dushyant Damania
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania)
| | - Miroslav Radulovic
- Department of Internal Medicine, James J. Peters VA Medical Center, Icahn School of Medicine, Bronx, NY, USA (Gavro Jelic, Miroslav Radulovic)
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6
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Zhang Q, Fu Z, Li S, Ding X, Zhang W, Ma R, Zhai Q. Clinical characteristics of three distinct types of pancreatitis with overlapping etiologies: A ten-year retrospective cohort study. Pancreatology 2023; 23:949-956. [PMID: 37968184 DOI: 10.1016/j.pan.2023.10.023] [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: 06/20/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Hypertriglyceridemia (HTG) is frequently observed in non-HTG-induced acute pancreatitis (AP), such as in the early stage of acute biliary pancreatitis (ABP). There is overlap in the etiologies of ABP, HTG-AP, and biliary-hypertriglyceridemia acute pancreatitis (BHAP), which may be perplexing for clinicians. METHODS We retrospectively analyzed 394 AP patients. The patients were divided into three groups based on etiology. We analyzed the differences among the three groups of patients in terms of general information, laboratory parameters, and prognosis. RESULTS The mean age of patients in the ABP group was significantly higher than that in the HTG-AP and BHAP groups (p < 0.001). Females made up a greater percentage of the ABP group, whereas males made up the majority in the HTG-AP and BHAP groups. The ABP group had the highest PCT, AMS, LPS, ALT, AST, GGT, TBIL, DBIL, APACHE II, and BISAP scores. TG and BMI were highest in the HTG-AP group. AST and GGT levels were substantially greater in BHAP patients than those in HTG-AP. The BHAP group had the greatest incidence of organ failure, systemic complications, and local complications. CONCLUSION ABP usually develops in people aged 50-59 years. HTG-AP primarily affects people aged 30-39 years. However, the peak incidence age of BHAP falls between the two aforementioned age groups (40-49 years). We also found that patients with BHAP seem to be in an intermediate state in terms of some biochemical markers and demographic characteristics. Furthermore, BHAP may have the worst clinical outcomes compared with HTG-AP and ABP.
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Affiliation(s)
- Qiwei Zhang
- Hepatobiliary and Pancreatic Surgery Dept, Banan Hospital of Chongqing Medical University, Chongqing, 401320, PR China.
| | - Zhan Fu
- Hepatobiliary and Pancreatic Surgery Dept, Banan Hospital of Chongqing Medical University, Chongqing, 401320, PR China.
| | - Shengwei Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
| | - Xiong Ding
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
| | - Wenfeng Zhang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
| | - Rong Ma
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
| | - Qilong Zhai
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
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7
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Ibarra F. Acute Management of Hypertriglyceridemia With a Disease-Specific Intravenous Insulin Infusion Order Set. Ann Pharmacother 2023; 57:1248-1254. [PMID: 36840326 DOI: 10.1177/10600280231155921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Hypertriglyceridemia-associated acute pancreatitis is a disease lacking a standardized management approach. OBJECTIVE The main objective of this study was to evaluate the safety and efficacy of a continuous intravenous insulin infusion order set specifically designed for managing hypertriglyceridemia. METHODS This study compared the safety and efficacy of a standardized (postintervention) approach to managing hypertriglyceridemia to a nonstandardized (preintervention) approach. The primary efficacy outcome was the percentage of patients who achieved a triglyceride level less than 500 mg/dL. Additional outcomes included the time to achieving a triglyceride level less than 500 mg/dL and the percent reduction in triglyceride levels. The primary safety outcome was the number of patients who experienced hypoglycemia (glucose less than 70 mg/dL). RESULTS Twenty patients were included in both the preintervention and postintervention groups. There was a significantly greater reduction in triglyceride levels observed in the postintervention group. The number of patients who achieved a triglyceride level less than 500 mg/dL in the preintervention and postintervention groups were 10 (50%) and 17 (85%), respectively, P = 0.018. Within the postintervention group, the time to achieving a triglyceride level less than 500 mg/dL in those with and without diabetes was 56.8 hours (38.2-64.0) versus 27.6 hours (19.7-45.0), respectively, P = 0.028. CONCLUSION AND RELEVANCE Our findings demonstrate that insulin infusions are safe and effective when therapy is standardized and accounts for nursing to patient ratios. Our results provide the medical community with a standardized approach to acutely managing hypertriglyceridemia.
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Affiliation(s)
- Francisco Ibarra
- Department of Pharmacy Services, Community Regional Medical Center, Fresno, CA, USA
- College of Osteopathic Medicine, California Health Sciences University, Clovis, CA, USA
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8
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Gubensek J. The role of apheresis and insulin therapy in hypertriglyceridemic acute pancreatitis-a concise review. BMC Gastroenterol 2023; 23:341. [PMID: 37789261 PMCID: PMC10546782 DOI: 10.1186/s12876-023-02957-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
Severe hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP) and is involved in its pathogenesis. Chylomicrons increase blood viscosity and induce ischemia, while free fatty acids induce inflammation and distant organ damage. Conservative treatment options include fasting and insulin; limited evidence shows their comparable efficacy. Plasma exchange might provide more rapid lowering of triglycerides and amelioration of systemic effects of severe AP. Available data from controlled studies show only moderately faster lowering of triglycerides with apheresis (about 70% vs. 50% with conservative treatment within 24 h) and limited data from non-randomized studies show no improvement in clinical outcomes. New evidence is expected soon from ongoing large randomized trials. Until then, insulin may be used in mild HTG-AP and plasma exchange should be considered only in severe HTG-AP, especially if the decline of triglycerides with conservative treatment is slow, and in HTG-AP during pregnancy.
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Affiliation(s)
- Jakob Gubensek
- Department of Nephrology, University Medical Center Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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9
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Metcalf RA, Cohn CS, Bakhtary S, Gniadek T, Gupta G, Harm S, Haspel RL, Hess AS, Jacobson J, Lokhandwala PM, Murphy C, Poston JN, Prochaska MT, Raval JS, Saifee NH, Salazar E, Shan H, Zantek ND, Pagano MB. Current advances in 2022: A critical review of selected topics by the Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee. Transfusion 2023; 63:1590-1600. [PMID: 37403547 DOI: 10.1111/trf.17475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/16/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND The Association for the Advancement of Blood and Biotherapies Clinical Transfusion Medicine Committee (CTMC) composes a summary of new and important advances in transfusion medicine (TM) on an annual basis. Since 2018, this has been assembled into a manuscript and published in Transfusion. STUDY DESIGN AND METHODS CTMC members selected original manuscripts relevant to TM that were published electronically and/or in print during calendar year 2022. Papers were selected based on perceived importance and/or originality. References for selected papers were made available to CTMC members to provide feedback. Members were also encouraged to identify papers that may have been omitted initially. They then worked in groups of two to three to write a summary for each new publication within their broader topic. Each topic summary was then reviewed and edited by two separate committee members. The final manuscript was assembled by the first and senior authors. While this review is extensive, it is not a systematic review and some publications considered important by readers may have been excluded. RESULTS For calendar year 2022, summaries of key publications were assembled for the following broader topics within TM: blood component therapy; infectious diseases, blood donor testing, and collections; patient blood management; immunohematology and genomics; hemostasis; hemoglobinopathies; apheresis and cell therapy; pediatrics; and health care disparities, diversity, equity, and inclusion. DISCUSSION This Committee Report reviews and summarizes important publications and advances in TM published during calendar year 2022, and maybe a useful educational tool.
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Affiliation(s)
- Ryan A Metcalf
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara Bakhtary
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Gaurav Gupta
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sarah Harm
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - Richard L Haspel
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron S Hess
- Departments of Anesthesiology and Pathology & Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Jessica Jacobson
- Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Parvez M Lokhandwala
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Colin Murphy
- TriCore Reference Laboratories, Albuquerque, New Mexico, USA
| | - Jacqueline N Poston
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Micah T Prochaska
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Eric Salazar
- Department of Pathology, UT Health San Antonio, San Antonio, Texas, USA
| | - Hua Shan
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Gligorijevic N, Stefanovic-Racic M, Kershaw EE. Medical management of hypertriglyceridemia in pancreatitis. Curr Opin Gastroenterol 2023:00001574-990000000-00085. [PMID: 37421386 DOI: 10.1097/mog.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) should be considered in all cases of acute pancreatitis and triglyceride levels measured early, so that appropriate early and long-term treatment can be initiated. RECENT FINDINGS In most cases of HTG-AP, conservative management (nothing by mouth, intravenous fluid resuscitation and analgesia) is sufficient to achieve triglyceride levels less than 500 mg/dl. Intravenous insulin and plasmapheresis are sometimes used, although prospective studies showing clinical benefits are lacking. Pharmacological management of hypertriglyceridemia (HTG) should start early and target triglyceride levels of less than 500 mg/dl to reduce the risk or recurrent acute pancreatitis. In addition to currently used fenofibrate and omega-3 fatty acids, several novel agents are being studied for long-term treatment of HTG. These emerging therapies focus mainly on modifying the action of lipoprotein lipase (LPL) through inhibition of apolipoprotein CIII and angiopoietin-like protein 3. Dietary modifications and avoidance of secondary factors that worsen triglyceride levels should also be pursued. In some cases of HTG-AP, genetic testing may help personalize management and improve outcomes. SUMMARY Patients with HTG-AP require acute and long-term management of HTG with the goal of reducing and maintaining triglyceride levels to less than 500 mg/dl.
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Affiliation(s)
- Nikola Gligorijevic
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Cao L, Chen Y, Liu S, Huang W, Wu D, Hong D, Wang Z, Sun Y, Qin K, Guo F, Luo C, Jiao Q, Luo X, Zhou J, Li G, Ye B, Chen T, Liu M, Mao W, Wang L, Li S, Windsor JA, Liu Y, Ke L, Tong Z, Li W. Early Plasmapheresis Among Patients With Hypertriglyceridemia-Associated Acute Pancreatitis. JAMA Netw Open 2023; 6:e2320802. [PMID: 37378979 DOI: 10.1001/jamanetworkopen.2023.20802] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
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.
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Affiliation(s)
- Longxiang Cao
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Yingjie Chen
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Quanzhou, China
| | - Siyao Liu
- Department of Emergency Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wei Huang
- West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Donghuang Hong
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Zuozheng Wang
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yi Sun
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, China
| | - Kaixiu Qin
- Department of Emergency Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Guo
- Department of Intensive Care Unit, Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Cuizhu Luo
- Department of Critical Care Medicine, Pingxiang People's Hospital, Pingxiang, China
| | - Qinghai Jiao
- Department of Critical Care Medicine, The First Hospital of Handan, Handan, China
| | - Xiang Luo
- Department of Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Gang Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bo Ye
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tao Chen
- Department of Public Health, Policy and Systems, Institute of Population Health, The University of Liverpool, Liverpool, United Kingdom
| | - Man Liu
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Wenjian Mao
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Lanting Wang
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shuai Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - John A Windsor
- Surgical and Translational Research Center, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Yuxiu Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
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Sundaram B, Pathak N, Nanda SK. Plasmapheresis can correct refractoriness of insulin on triglyceride metabolism - A case report of hypertriglyceridemia-induced acute pancreatitis. Arch Clin Cases 2023; 10:70-73. [PMID: 37223697 PMCID: PMC10201372 DOI: 10.22551/2023.39.1002.10244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Hypertriglyceridemia associated acute pancreatitis is a medical emergency and it causes significant morbidity and mortality. Here we report a case of 47 years old male with hypertriglyceridemia associated acute pancreatitis. The diagnosis was confirmed by elevated serum triglyceride levels and elevated lipase levels. Initially, Insulin infusion started with fibrates and statins but due to worsening hypertriglyceridemia and he underwent one session of plasmapheresis, following which triglyceride levels improved. Triglyceride assessment in removed plasma in plasmapheresis showed that the amount of triglyceride level reduction was 4 times the amount removed in plasmapheresis. The study showed that plasmapheresis improves insulin-related triglyceride metabolism besides removal.
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Affiliation(s)
- Bala Sundaram
- Department of General Medicine, Pondicherry institute of medical sciences, Pondicherry, India
| | - Nabadwip Pathak
- Department of nephrology, Pondicherry institute of Medical sciences, Pondicherry, India
| | - Sunil Kumar Nanda
- Department of Biochemistry, Pondicherry institute of medical sciences, Pondicherry, India
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Yang QY, Zhao Q, Hu JW. Incidence and clinical treatment of hypertriglyceridemic acute pancreatitis: A few issues. World J Clin Cases 2023; 11:479-481. [PMID: 36686359 PMCID: PMC9850974 DOI: 10.12998/wjcc.v11.i2.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/16/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Hypertriglyceridemia is a well-recognized etiology of acute pancreatitis, and the incidence of hypertriglyceridemic acute pancreatitis (HTG-AP) has increased in frequency worldwide in response to lifestyle changes. It is crucial to identify hypertriglyceridemia as the cause of pancreatitis and initiate appropriate treatment. Insulin treatment produces effective lowering of triglycerides, but in our opinion, non-diabetic patients with HTG-AP require separate consideration to avoid hypoglycemia.
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Affiliation(s)
- Qun-Ying Yang
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Qian Zhao
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Jian-Wen Hu
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
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14
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Kozlov A, Becher MU, Schlecker S. [Hypertriglyceridemic pancreatitis and cardiac tamponade in a 26-year-old woman]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:88-92. [PMID: 36418500 DOI: 10.1007/s00108-022-01434-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/25/2022]
Abstract
A 26-year-old woman with type 2 diabetes mellitus and discontinued intensive conventional insulin therapy was admitted to the authors' hospital with acute upper abdominal pain. Severe hypertriglyceridemia and acute pancreatitis were diagnosed. Treatment included insulin administration and plasmapheresis. On day 3, the patient developed sudden haemodynamic instability and in-hospital cardiopulmonary arrest. Focused echocardiography showed pericardial effusion with right ventricular collapse. Pericardiocentesis was performed, leading to a return of spontaneous circulation.
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Affiliation(s)
- A Kozlov
- Zentrum für Innere Medizin, Medizinische Klinik II für Kardiologie, Rhythmologie, Pneumologie und Internistische Intensivmedizin, Städtisches Klinikum Solingen, Gotenstr. 1, 42653, Solingen, Deutschland.
| | - M U Becher
- Zentrum für Innere Medizin, Medizinische Klinik II für Kardiologie, Rhythmologie, Pneumologie und Internistische Intensivmedizin, Städtisches Klinikum Solingen, Gotenstr. 1, 42653, Solingen, Deutschland
| | - S Schlecker
- Zentrum für Innere Medizin, Medizinische Klinik II für Kardiologie, Rhythmologie, Pneumologie und Internistische Intensivmedizin, Städtisches Klinikum Solingen, Gotenstr. 1, 42653, Solingen, Deutschland
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Gubensek J. Insulin therapy in hypertriglyceridemia-associated acute pancreatitis - Some considerations. Pancreatology 2022; 22:1061-1062. [PMID: 36369232 DOI: 10.1016/j.pan.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Jakob Gubensek
- Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Muacevic A, Adler JR, Brás C, Curto A, Silveira Ramos M, Madeira C. Plasmapheresis as an Alternative Treatment of Hypertriglyceridemia-Induced Pancreatitis: A Case Report. Cureus 2022; 14:e32000. [PMID: 36589169 PMCID: PMC9798146 DOI: 10.7759/cureus.32000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
Hypertriglyceridemia-induced pancreatitis is a relatively common form of acute pancreatitis that may represent up to 10% of all etiologies of this condition. Due to its specific pathogenic mechanisms related to high serum triglyceride levels, different treatment options have been proposed, including insulin perfusion, heparin perfusion, and plasmapheresis. Although the superiority of plasmapheresis in this clinical setting has not been demonstrated in randomized clinical trials, many centers have reported its effectiveness and considered this as a possible alternative according to the current guidelines. We report a case of a young patient diagnosed with hypertriglyceridemia-induced pancreatitis that was successfully treated with plasmapheresis. Since complications associated with plasmapheresis are rare and other therapeutic options may not be so effective or safe, we believe that this should be a valid alternative treatment that may be offered to these patients. More studies are still needed to further evaluate its effectiveness and to elucidate if there is a subset of patients in whom treatment with plasmapheresis may be more beneficial.
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Lv YC, Yao YH, Wu DB, Lei JJ. Value of BISAP score for predicting severity of hyperlipidemic acute pancreatitis: A meta-analysis. Shijie Huaren Xiaohua Zazhi 2022; 30:710-717. [DOI: 10.11569/wcjd.v30.i16.710] [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: 02/07/2023] Open
Abstract
BACKGROUND Early identification of hyperlipidemic acute pancreatitis (HLAP) patients at risk of developing potentially lethal complications is of great clinical significance. Studies have suggested that the bedside index for in acute pancreatitis (BISAP) score is associated with adverse outcomes.
AIM To assess the accuracy of BISAP score as a prognostic marker for severity of HLAP.
METHODS A systematic search of main computerized databases was performed to identify eligible cohort studies on the predictive value of BISAP score for severity of HLAP. The STATA software and Meta-disc software were applied to carry out the meta-analysis.
RESULTS Ten studies (n = 1591) were included. The overall sensitivity and specificity of BISAP score ≥ 3 for predicting mortality in HLAP were 0.85 (95% confidence interval [CI]: 0.65-0.96) and 0.86 (95%CI: 0.82-0.88), respectively; the area under the curve (AUC) was 0.937, and the diagnostic odds ratio (DOR) was 42.00 (95%CI: 12.86-139.12). Regarding the increase of BISAP score for prediction of severe acute pancreatitis (SAP), the pooled sensitivity was 0.69 (95%CI: 0.61-0.76), and the specificity was 0.82 (95%CI: 0.78-0.85), with AUC and DOR being 0.900 and 18.47 (95%CI: 6.82-42.03), respectively. The pooled sensitivity, specificity, and DOR for prediction of moderately severe acute pancreatitis (MASP) + SAP were 0.54 (95%CI: 0.50-0.63), 0.91 (95%CI: 0.89-0.93), and 15.55 (95%CI: 6.91-34.99), respectively; the AUC was 0.724. BISAP score was superior to APACH Ⅱ and Ranson score in predicting the severity of HLAP.
CONCLUSION BISAP score is a reliable tool to identify the severity of HLAP, but it has a suboptimal sensitivity for predicting SAP and SAP + MSAP.
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Affiliation(s)
- Yong-Cai Lv
- Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People's Hospital, Zhenning 561200, Guizhou Province, China
| | - Yan-Hua Yao
- Department of Ultrasound, Zhenning Buyi and Miao Autonomous County Traditional Chinese Hospital, Zhenning 561200, Guizhou Province, China
| | - De-Biao Wu
- Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People's Hospital, Zhenning 561200, Guizhou Province, China
| | - Jing-Jing Lei
- Department of Geriatric Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
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