PMID- 25047332
OWN - NLM
STAT- MEDLINE
DCOM- 20150407
LR  - 20220330
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 9
IP  - 7
DP  - 2014
TI  - Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with 
      plasma exchange: an observational cohort study.
PG  - e102748
LID - 10.1371/journal.pone.0102748 [doi]
LID - e102748
AB  - OBJECTIVES: The optimal therapy for hypertriglyceridemic acute pancreatitis, 
      especially the role of plasma exchange (PE), is not entirely clear. The aim of 
      our large, single-center, observational, cohort study was to analyze the factors 
      affecting outcome in hypertriglyceridemic pancreatitis treated with PE. METHODS: 
      We included 111 episodes of hypertriglyceridemic pancreatitis treated with PE, 
      which occurred in 103 different patients. The Acute Physiology and Chronic Health 
      Evaluation (APACHE) II score, triglycerides, delay to first PE, and PE treatment 
      details were retrospectively obtained from the patients' records. The main 
      outcome measures were length of hospitalization and in-hospital mortality. 
      RESULTS: The patients were 47+/-9 years old and the median APACHE II score at first 
      PE was 4 (inter-quartile range (IQR) 2-7). There was a seasonal variation in the 
      incidence of hypertriglyceridemic pancreatitis, and the recurrence rate was 1.6% 
      per year. Triglycerides at presentation did not correlate with APACHE II or 
      influence the outcome. The mean reduction in triglycerides during PE was 59% 
      (from 44+/-31 to 18+/-15 mmol/l), which was twice the reduction observed during 
      conservative treatment (27% daily). The median hospital stay was 16 days (IQR 
      10-24) and in-hospital mortality was 5%. The median delay to first PE was 35 
      hours (IQR 24-52), and there was no difference in mortality in the early and late 
      PE groups (7% vs. 6%, p = 0.79). The group with citrate anticoagulation during PE 
      had a significantly lower mortality than the group with heparin anticoagulation 
      (1% vs. 11%, p = 0.04), and citrate was an independent predictor also in the 
      multivariate model (p = 0.049). CONCLUSIONS: PE effectively reduced serum 
      triglycerides faster than could be expected with conservative treatment. The 
      delay in PE therapy did not influence survival. We found that citrate 
      anticoagulation during PE was associated with reduced mortality, which should be 
      confirmed in a randomized study.
FAU - Gubensek, Jakob
AU  - Gubensek J
AD  - Department of Nephrology, University Medical Center Ljubljana, Ljubljana, 
      Slovenia.
FAU - Buturovic-Ponikvar, Jadranka
AU  - Buturovic-Ponikvar J
AD  - Department of Nephrology, University Medical Center Ljubljana, Ljubljana, 
      Slovenia.
FAU - Romozi, Karmen
AU  - Romozi K
AD  - Department of Nephrology, University Medical Center Ljubljana, Ljubljana, 
      Slovenia.
FAU - Ponikvar, Rafael
AU  - Ponikvar R
AD  - Department of Nephrology, University Medical Center Ljubljana, Ljubljana, 
      Slovenia.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20140721
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Triglycerides)
SB  - IM
MH  - APACHE
MH  - Adult
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Hyperglycemia/blood/*complications/*therapy
MH  - Male
MH  - Middle Aged
MH  - Pancreatitis/blood/*complications/*therapy
MH  - *Plasma Exchange/methods
MH  - Treatment Outcome
MH  - Triglycerides/*blood
PMC - PMC4105439
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2014/07/23 06:00
MHDA- 2015/04/08 06:00
PMCR- 2014/07/21
CRDT- 2014/07/23 06:00
PHST- 2014/03/10 00:00 [received]
PHST- 2014/06/23 00:00 [accepted]
PHST- 2014/07/23 06:00 [entrez]
PHST- 2014/07/23 06:00 [pubmed]
PHST- 2015/04/08 06:00 [medline]
PHST- 2014/07/21 00:00 [pmc-release]
AID - PONE-D-14-10545 [pii]
AID - 10.1371/journal.pone.0102748 [doi]
PST - epublish
SO  - PLoS One. 2014 Jul 21;9(7):e102748. doi: 10.1371/journal.pone.0102748. 
      eCollection 2014.