TPE vs. insulin for hypertriglyceridemia-induced acute pancreatitis

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Created On: 31/12/2024

Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) poses a treatment dilemma due to the absence of a curative therapy. While therapeutic plasma exchange (TPE) and insulin are frequently used, there’s limited evidence regarding their effectiveness. Hence, this study aimed to clarify their roles in managing this condition.

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Key take away

In hypertriglyceridemia-induced acute pancreatitis patients, therapeutic plasma exchange reduces triglyceride levels faster than insulin in the first 24 hours, but not after 48 hours. Insulin could be a viable treatment for selected patients.

Background

Method

This retrospective, single-center study analyzed 33 patients treated with TPE and 56 patients treated with insulin. The proportion of triglyceride decrease within two days of hospital admission was the key outcome ascertained.

Result

TPE showed a trend for greater triglyceride reduction at 24 hours than insulin (62.5% for TPE vs. 55.7% for insulin). However, at 48 hours, reductions were similar (83.6% for insulin vs. 81.9% for TPE). TPE patients had longer hospital stays (10 vs. 6 days), but there were no differences in mortality or time to achieve triglyceride levels below <11.3 mmol/L.

Conclusion

For patients with HTG-AP, TPE achieved quicker triglyceride reduction than insulin in the first 24 hours, but both treatments showed similar effectiveness after 48 hours. Insulin may serve as a promising and convenient therapeutic choice for carefully selected HTG-AP patients.

While TPE was more potent in lowering triglycerides within the first 24 hours for patients with HTG-AP, both TPE and insulin produced comparable results after 48 hours, pointing to insulin as a convenient alternative.