Effect of different modes of TPE on the prognosis of hypertriglyceridemic acute pancreatitis: a single-center retrospective study

Background: The management and treatment of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are similar to those of other causes of AP and include fluid resuscitation, nutritional support, and pain control. Along with supportive care, treatments for HTG specifically include therapeutic plasma exchange (TPE) to reduce the level of serum triglyceride (TG) which are crucial for the treatment and prognosis of HTG-AP patients. Aim: The purpose of this study was to evaluate the effects of different TPE modes [centrifugal TPE (cTPE) and membrane TPE (mTPE)] on the prognosis and clinical benefit of HTG-AP. Methods: This observational cohort study was conducted on 49 patients with HTG-AP who presented between January 2021 and December 2024. The patients were divided into the cTPE group and mTPE group based on the mode they received for TPE. Data were collected from patients included clinical characteristics, biochemical indices, therapeutic outcomes, and adverse events. Results: 65.36% in the mTPE group. Both modes of TPE resulted in a significant decrease in platelet levels (11.75% cTPE group, 23.89% mTPE group). However, both modes of TPE improved the coagulation dysfunction of HTG-AP patients, cTPE significantly reduced D-dimer levels and improved the PH of HTG-AP patients when compared to mTPE. Furthermore, there was a significant difference in the cost of a single TPE between the two groups, and the cost of cTPE was lower. Conclusion: This was the first study to compare the clinical benefits of cTPE and mTPE during the treatment of HTG-AP. cTPE showed a more significant advantage in improving coagulation function and pH, and the reduction of TC level in the cTPE group was more prominent. Additionally, the single cost of cTPE is lower. But there is insufficient evidence that cTPE is more beneficial for HTG-AP than mTPE, performing cTPE in combination with other therapies may be beneficial.