Therapeutic Outcomes and Risks of Plasmapheresis in Hypertriglyceridemia Acute Pancreatitis: A Systematic Review and Meta-analysis.

BACKGROUND: Hypertriglyceridemia acute pancreatitis (HTG-AP) is constantly increasing and has a higher proportion of severe cases. The benefit of plasmapheresis as a therapeutic intervention for HTG-AP remains controversial. Thus we conducted a meta-analysis to search existing evidence to evaluate its efficacy and safety. METHODS: A comprehensive literature search was performed in key electronic databases to search eligible studies based on predetermined criteria. Included studies compared plasmapheresis combined with standard medical therapy (Plasmapheresis group, PE group) versus standard medical therapy alone (Control group) in HTG-AP patients. Study outcomes were the 24-hour serum triglyceride (TG) reduction rate, in-hospital mortality, incidence of local/systemic complications, hospital length of stay (LOS), hospitalization costs, and recurrence rate. RESULTS: A total of 986 articles were retrieved and 20 studies involving 1,576 patients (PE group: n=636; Control group: n=940) were included. Analysis revealed that no statistically significant difference was found in mortality (RR 1.43, 95%CI 0.91-2.26, P=0.12), incidence of systemic complications (RR: 0.96; 95%CI: 0.61-1.50; P = 0.86), incidence of local complications (RR 1.01, 95% CI 0.84-1.21; P=0.91) , requirement for invasive procedures (RR 0.86, 95% CI 0.48-1.54, P=0.62) between PE group and Control group. PE group has higher TG reduction at both 24h (SMD 10.13, 95% CI 3.39-16.87, P<0.01) and 48h (SMD 8.14, 95%CI 4.30-11.98, P<0.0001) compared with control group. PE group exhibited a prolonged LOS (WMD 2.40, 95%CI 0.14-4.66, P=0.04) alongside substantially increased costs (WMD 27.56, 95%CI 16.61-38.51, P<0.00001). Subgroup analysis indicated plasmapheresis increased mortality in non-severe cases. CONCLUSION: While plasmapheresis significantly reduces serum TG levels, it confers no significant benefit on critical clinical outcomes in HTG-AP. Thus existing clinical evidence does not support its use as a routine treatment for HTG-AP. Large-scale RCTs should be carried out to further evaluate its efficacy, optimal indications, and timing. KEY WORDS: plasmapheresis; plasma exchange; double filtration plasmapheresis; hypertriglyceridemic acute pancreatitis; meta-analysis.