Intensive Care and Pain Medicine, Kfar Saba, Israel Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
J Intensive Care Med. 2022 Sep;37(9):1174-1178. doi: 10.1177/08850666211054365. Epub 2021 Nov 3.
Hypertriglyceridemia-induced acute pancreatitis (HIAP) may result in severe morbidity and mortality. The most effective management strategy is unknown. While plasmapheresis is often performed, it is possible that a conservative approach which includes fasting, intravenous fluids and high-dose insulin, may be successful.
To compare the 28 day mortality and morbidity parameters among patients admitted to the intensive care unit (ICU) due to HIAP when treated conservatively, as compared to patients who were treated with plasmapheresis.
A retrospective study was performed, including all patients at least 18 years of age who were admitted to the ICU between the years 2010 to 2020 with diagnosis of HIAP. Patients underwent plasmapheresis or were managed conservatively. Collected data included patient demographics, chronic illness and medications, hospital and ICU admission times, 28-day mortality, need for ventilation, number of ventilation days, need for inotropic support, daily triglyceride levels, APACHE II score, lactate on admission, need for dialysis, antibiotic treatment, surgical or percutaneous intervention.
The study included 29 patients. Twenty two patients were treated conservatively and 7 patients with plasmapheresis. There were no significant statistical differences between the groups regarding demographic parameters, chronic disease and medications. Furthermore, on ICU admission and during the subsequent 4 days APACHE score, serum lactate and triglyceride levels were similar between the groups. There was no significant difference in mortality. However, plasmapheresis was associated with greater morbidity (longer admission times, need for ventilation and number of ventilation days, need for inotropic support and dialysis, and invasive surgical intervention). Finally, when compared to conservative management, the rate of serum triglyceride decrease was not improved following plasmapheresis.
Efficacy of conservative treatment in lowering the serum triglyceride level in HIAP is similar to plasmapheresis. Due to the small patient cohort further prospective studies are needed to confirm these findings.
高甘油三酯血症引起的急性胰腺炎（HIAP）可能导致严重的发病率和死亡率。目前尚不清楚最有效的治疗策略。虽然经常进行血浆置换，但禁食、静脉补液和大剂量胰岛素的保守治疗也可能成功。
比较因 HIAP 入住重症监护病房（ICU）的患者接受保守治疗与接受血浆置换治疗的 28 天死亡率和发病率参数。
进行了一项回顾性研究，纳入了 2010 年至 2020 年间至少 18 岁因 HIAP 入住 ICU 的所有患者。患者接受了血浆置换或保守治疗。收集的数据包括患者的人口统计学特征、慢性疾病和药物治疗、住院和 ICU 入住时间、28 天死亡率、需要通气、通气天数、需要正性肌力支持、每日甘油三酯水平、APACHE II 评分、入院时的血乳酸、需要透析、抗生素治疗、手术或经皮介入。
该研究纳入了 29 例患者。22 例患者接受保守治疗，7 例患者接受血浆置换。两组患者在人口统计学参数、慢性疾病和药物治疗方面无显著统计学差异。此外，两组在入住 ICU 时以及随后的 4 天内，APACHE 评分、血清乳酸和甘油三酯水平相似。死亡率无显著差异。然而，血浆置换与更高的发病率相关（住院时间更长、需要通气和通气天数、需要正性肌力支持和透析、以及侵入性手术干预）。最后，与保守治疗相比，血浆置换并未改善血清甘油三酯水平的降低。
保守治疗在降低 HIAP 患者血清甘油三酯水平方面的疗效与血浆置换相似。由于患者队列较小，需要进一步进行前瞻性研究以证实这些发现。
