治疗性血浆置换对高甘油三酯血症相关性急性胰腺炎患者器官衰竭持续时间的影响。
Impact of therapeutic plasmapheresis on the duration of organ failure in patients with hypertriglyceridemia-associated acute pancreatitis.
作者信息
Wang Lanting, Zhou Jing, Lv Cheng, Hong Donghuang, Wang Zuozheng, Mao Wenjian, Liu Yuxiu, Zhang Zixiong, Li Yuanzhen, Li Gang, Ye Bo, Li Baiqiang, Cao Longxiang, Tong Zhihui, Li Weiqin, Ke Lu
机构信息
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.
出版信息
Ann Intensive Care. 2024 Apr 15;14(1):57. doi: 10.1186/s13613-024-01285-3.
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.
背景
血浆置换广泛应用于严重高甘油三酯血症相关性急性胰腺炎（HTG-AP），以清除血浆中过多的甘油三酯。本研究旨在评估血浆置换是否能缩短HTG-AP患者器官衰竭的持续时间。
方法
我们分析了一个多中心、前瞻性、长期运行的注册研究（PERFORM）中的一组患者，该研究收集了症状发作后72小时内入住研究地点的HTG-AP患者。本研究基于2020年11月至2023年3月收集的数据。纳入分析的是入组时出现器官衰竭的患者。主要结局是14天内器官衰竭缓解的时间。采用多变量Cox回归模型评估血浆置换与器官衰竭缓解时间之间的关联。使用有向无环图（DAG）识别潜在的混杂因素。
结果
共纳入122例HTG-AP患者（入组时序贯器官衰竭评估（SOFA）评分的中位数[四分位间距]为3.00[2.00 - 4.00]）。在研究患者中，46例行血浆置换，76例接受药物治疗。DAG显示，基线血清甘油三酯、急性生理与慢性健康状况评分系统II（APACHE II）评分、呼吸衰竭、心血管衰竭和肾衰竭是潜在的混杂因素。在对选定的混杂因素进行调整后，接受血浆置换的患者与仅接受药物治疗的患者在器官衰竭缓解时间上无显著差异（风险比[HR]=1.07；95%置信区间[CI]0.68 - 1.68；P = 0.777）。此外，血浆置换的使用与更高的重症监护病房（ICU）需求相关（97.8%[45/46]对65.8%[50/76]；比值比[OR]，19.33；95%CI 2.20至169.81；P = 0.008）。
结论
在早期出现器官衰竭的HTG-AP患者中，与药物治疗相比，血浆置换与加速器官衰竭缓解无关，但可能与更多患者入住ICU相关。
试验注册
PERFORM研究已在中国临床试验注册中心注册（ChiCTR2000039541）。2020年10月30日注册。
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