Benjamin Click1, Andrea M Ketchum2, Rose Turner2, David C Whitcomb1, Georgios I Papachristou1, Dhiraj Yadav3. 1. Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 2. Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA. 3. Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: yadavd@upmc.edu.
Abstract
BACKGROUND: Mostly published as case reports or series, the role of apheresis in hypertriglyceridemia (HTG)-related acute pancreatitis (AP) remains unclear. We performed a systematic review of available literature on this topic with specific focus on disease severity. METHODS: A search of electronic databases (PubMed, EMBASE, Cochrane) and gray literature yielded 5020 articles of which 74 met criteria for inclusion (301 unique patients). Relevant data were abstracted from full manuscripts and analyzed. RESULTS: Most patients were young (mean age 37.9 ± 10.4 years) and male (71.5%). About two-thirds (69.7%) received apheresis within 48 h and most required only 1 or 2 sessions (84.4%). Apheresis resulted in an average reduction of serum TG by 85.4% (p < 0.001). There was high variability in reporting the presence of and criteria to define severe AP (reported 221/301, 73.4%; present 85/221, 38.5%) or organ failure (reported 104/301, 34.6%; present 52/104, 50.0%). Improvement was reported in the majority of patients (reported 144/301, 47.8%, present 136/144, 94.4%) mainly by clinical symptoms or laboratory tests. Overall mortality was 7.1% (21/294) which increased to 11.8% (10/85) with severe AP and 19.2% (10/52) with organ failure. CONCLUSIONS: Apheresis effectively reduces serum TG levels. However, due to uncontrolled data, reporting bias and lack of a comparison group, definitive conclusions on the efficacy of apheresis in reducing AP severity cannot be made. We propose which patients may be best suitable for apheresis, type of studies needed and outcome measures to be studied in order to provide empiric data on the role of apheresis in HTG-related AP.
BACKGROUND: Mostly published as case reports or series, the role of apheresis in hypertriglyceridemia (HTG)-related acute pancreatitis (AP) remains unclear. We performed a systematic review of available literature on this topic with specific focus on disease severity. METHODS: A search of electronic databases (PubMed, EMBASE, Cochrane) and gray literature yielded 5020 articles of which 74 met criteria for inclusion (301 unique patients). Relevant data were abstracted from full manuscripts and analyzed. RESULTS: Most patients were young (mean age 37.9 ± 10.4 years) and male (71.5%). About two-thirds (69.7%) received apheresis within 48 h and most required only 1 or 2 sessions (84.4%). Apheresis resulted in an average reduction of serum TG by 85.4% (p < 0.001). There was high variability in reporting the presence of and criteria to define severe AP (reported 221/301, 73.4%; present 85/221, 38.5%) or organ failure (reported 104/301, 34.6%; present 52/104, 50.0%). Improvement was reported in the majority of patients (reported 144/301, 47.8%, present 136/144, 94.4%) mainly by clinical symptoms or laboratory tests. Overall mortality was 7.1% (21/294) which increased to 11.8% (10/85) with severe AP and 19.2% (10/52) with organ failure. CONCLUSIONS: Apheresis effectively reduces serum TG levels. However, due to uncontrolled data, reporting bias and lack of a comparison group, definitive conclusions on the efficacy of apheresis in reducing AP severity cannot be made. We propose which patients may be best suitable for apheresis, type of studies needed and outcome measures to be studied in order to provide empiric data on the role of apheresis in HTG-related AP.
Authors: Sohail Z Husain; Veronique Morinville; John Pohl; Maisam Abu-El-Haija; Melena D Bellin; Steve Freedman; Peter Hegyi; Melvin B Heyman; Ryan Himes; Chee Y Ooi; Sarah J Schwarzenberg; Danielle Usatin; Aliye Uc Journal: J Pediatr Gastroenterol Nutr Date: 2016-04 Impact factor: 2.839
Authors: Andrea Párniczky; Balázs Kui; Andrea Szentesi; Anita Balázs; Ákos Szűcs; Dóra Mosztbacher; József Czimmer; Patrícia Sarlós; Judit Bajor; Szilárd Gódi; Áron Vincze; Anita Illés; Imre Szabó; Gabriella Pár; Tamás Takács; László Czakó; Zoltán Szepes; Zoltán Rakonczay; Ferenc Izbéki; Judit Gervain; Adrienn Halász; János Novák; Stefan Crai; István Hritz; Csaba Góg; János Sümegi; Petra Golovics; Márta Varga; Barnabás Bod; József Hamvas; Mónika Varga-Müller; Zsuzsanna Papp; Miklós Sahin-Tóth; Péter Hegyi Journal: PLoS One Date: 2016-10-31 Impact factor: 3.240