Efficacy and cost of double filtration plasmapheresis in severe hypertriglyceridemia-induced pancreatitis: A retrospective observational study

Efficacy and cost of double filtration plasmapheresis in severe hypertriglyceridemia-induced pancreatitis: A retrospective observational study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy and cost of double filtration plasmapheresis in severe hypertriglyceridemia-induced pancreatitis: A retrospective observational study Pan Han, Chenyang Gao, Xin Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1429591/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The value of double filtration plasmapheresis (DFPP) in severe hypertriglyceridemia-induced pancreatitis (sHTGP) is controversial. This study aimed to investigate the efficacy of DFPP on clinical results in patients with sHTGP and the costs associated with the procedure. Methods Patients who underwent DFPP after admission between January 2016 and December 2021 were recruited. Data on lipid profile, clinical results, and costs were retrospectively collected and analyzed. Results Fifty sHTGP patients who received DFPP were enrolled. All of the lipid profile were significantly reduced and maintained a downward trend. The APACHE II score on admission was higher and the reduction after DFPP was more obvious ( P < 0.05) in patients with higher triglyceride (TG) levels (≥ 33.9 mmol/L) than in patients with lower TG levels. More material fees were expended in the higher TG group due to more DFPP sessions ( P < 0.05), but no significant differences existed in total hospital costs between the two groups. Conclusion DFPP could rapidly and effectively reduce TGs to a safe level. APACHE II score reduction was obvious in patients with TGs ≥ 33.9 mmol/L and was associated with lipid profile changes. DFPP may benefit sHTGP patients with a TG level higher than the current initiation threshold. Double filtration plasmapheresis acute hypertriglyceridemia-induced pancreatitis clinical results costs Figures Figure 1 Figure 2 Background Acute pancreatitis (AP) is a life-threatening disease resulting from various potential etiologies. Hypertriglyceridemia is the third leading cause of AP, accounting for approximately 7% of all cases. Severe hypertriglyceridemia-induced pancreatitis (sHTGP) differs from other causes due to its worse clinical course and outcomes(1). Severe hypertriglyceridemia, characterized by a triglyceride (TG) level ≥11.3 mmol/L, is thought to trigger sHTGP. The pathophysiology of sHTGP is presumed to involve lipotoxicity of TG breakdown and activation of the inflammatory response, and the severity and clinical course are associated with these mechanisms(2). Therefore, the primary management is to immediately decrease the TG level to the target of 5.65 mmol/L. Extracorporeal apheresis is an effective option for sHTGP patients, which can eliminate cytokines and proinflammatory markers and improve clinical symptoms, morbidity, and mortality(3). Double filtration plasmapheresis (DFPP) is a selective plasma component separation therapy based on a two-type filter system that can also have a triglyceride-lowering effect. DFPP is the main modality in our center, resulting from the shortage of plasma and the desire to avoid transfusion adverse effects. To date, the efficacy and cost of DFPP for sHTGP patients is still controversial. The goals of this study were to describe lipid profile alterations after DFPP in sHTGP patients and to explore the relationship between these alterations and clinical improvement. Methods This retrospective observational study was approved by the ethics committee. Patients This study was conducted in the Department of General ICU from January 2016 to December 2021. Patients were recruited once AP was identified. Age < 18 years, pregnancy, other etiologies of AP, TG level＜11.3 mmol/L, contraindication for DFPP, and incomplete data were the exclusion criteria. DFPP DFPP was conducted by a PlasautoΣ™ (Asahi Kasei, Japan) equipped with a plasma separator (Plasmaflo™ OP-08) and plasma component separator (Cascadeflo TM EC-50 W). Vascular access was mostly through the femoral vein. An average of 1.5-time plasma volume was processed. The blood flow rate, plasma separation rate, and discarding rate were 100 mL/min, 20%, and 10%, respectively. Heparin was administered for anticoagulation during the entire procedure. Once the TG level (<5.6 mmol/L) was achieved, no additional sessions were delivered. Data collection Electronic medical records were reviewed for baseline characteristics, including demographic data, body mass index (BMI), comorbidities, time from onset to admission, BISAP score, Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The lipid profile, including TG, total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), was collected before DFPP, after the first session, and upon transfer/discharge. Clinical outcomes were depicted by APACHE II and SOFA scores after all sessions, local complications, mortality, and length of ICU and hospital stays. Hospital expenses were divided into total fees, professional fees and nonprofessional fees, and the latter item was divided into medication and material fees. Statistical analysis Patients were divided into higher and lower TG groups based on the TG level of 33.9 mmol/L (3 times the upper limit). Continuous variables with a normal distribution were described as the mean ± SD and were analyzed by t-test, while continuous variables with a nonnormal distribution were reported as the median (interquartile range) and were analyzed using the Mann–Whitney test. The association between lipid profile and APACHE II score changes was revealed using linear regression analysis. P <0.05 was judged to indicate statistical significance. Data were analyzed using SPSS 24.0 and GraphPad Prism 9.0. Results Patient characteristics During this investigation, 63 patients were admitted and diagnosed with AP. Fifty sHTGP patients were recruited after exclusions (Fig. 1). The baseline characteristics are described in Table 1. The mean age was 37.7 ± 10.5 years (range: 21–65 years), and 39 (78.0%) patients were men. The average number of days from disease onset to admission were 1.2 ± 0.7 d. Sixteen (32.0%) patients had recurrent AP, and 20 (40.0%) patients had a past medical history of hyperlipidemia. Thirty (60.0%) patients were complicated with various risk factors, including diabetes (28.0%), alcohol abuse (24.0%) and medication history (26.0%). On admission, the average APACHE II score in the higher TG group was significantly higher than that in the lower TG group ( P < 0.05). Table 1 Baseline characteristics of the patients Variables All patients ( n = 50) Lower group ( n = 24) Higher group ( n = 26) P Age, median (IQR), y 37.7(29.8–44.0) 37.0(28.0-43.8) 38.4(30.8–44.8) 0.719 Male, n (%) 39 (78.0) 21(87.5) 18(69.2) 0.123 BMI, mean ± SD, kg/m 2 27.2 ± 4.0 27.5 ± 3.7 27.0 ± 4.4 0.628 Recurrence, n (%) 16(32) 8(33.3) 8(30.8) 0.848 Preexisting comorbidities Hyperlipidemia, n (%) 20(40) 9(37.5) 11(42.3) 0.731 Diabetes, n (%) 14(28) 6(25.0) 8(30.8) 0.653 Alcohol abuse, n (%) 12(24) 4(16.7) 8(30.8) 0.248 Medication, n (%) 13(26) 7(29.2) 6(23.1) 0.627 Onset to admission, median (IQR), d 1.2(0.7-2.0) 1.3(1.0–2.0) 1.2(0.58–1.3) 0.368 Disease severity BISAP score, median (IQR) 2.1(2.0–2.0) 2.0(2.0–2.0) 2.15(2.0–2.0) 0.274 Before-APACHE II score, median (IQR) 11.5(7.0–14.0) 9.9(6.0-12.8) 13.0(9.0-17.3) 0.039 Before-SOFA, median (IQR) 3.1(1.0–4.0) 3.1(1.3–4.8) 3.0(1.0–4.0) 0.860 Lipid profile changes In addition to adjunctive therapy, all patients underwent DFPP within 24 hours of admission without any complications. The majority of patients (n = 46, 92.0%) received fewer than 3 sessions, with 26 (52.0%) patients receiving only one session. Patients in the higher TG group experienced more sessions than those in the lower TG group ( P < 0.01). The lipid profile presented a distinct difference after DFPP and remained stable (Fig. 2). The TG level was remarkably reduced by 71.9% on average ( P < 0.01), and the levels of TC, HDL, and LDL all synchronously decreased ( P < 0.05). Compared to the lower TG group, DFPP generated a stronger TG-lowering effect in the higher TG group ( P 0.05). Table 2 Therapy and lipid profile changes Variables All patients ( n = 50) Lower group ( n = 24) Higher group ( n = 26) P Session, median (IQR), n 1.6(1.0–2.0) 1.3(1.0-1.8) 1.8(1.0–2.0) 0.003 Adjunctive therapy Somatostatin, n (%) 46(92.0) 21(87.5) 25(96.2) 0.265 Insulin, n (%) 26(52.0) 14(58.3) 12(46.2) 0.394 Fibrate, n (%) 41(82.0) 19(79.2) 22(84.6) 0.620 TG level Before DFPP, median (IQR), mmol/L 44.2(23.8–63.3) 24.3(19.2–30.4) 62.6(42.2–75.1) 0.000 First session, median (IQR), mmol/L 12.4(3.0-16.2) 6.0(2.7–5.9) 18.3(4.8–21.3) 0.001 TG reduction, median (IQR), mmol/L 31.8(18.8–42.1) 18.3(13.8–26.8) 44.3(33.8–53.8) 0.000 Transfer/discharge, median (IQR), mmol/L 3.7(2.7–4.4) 3.3(2.6–4.2) 4.0(3.3–4.8) 0.023 TC level Before DFPP, median (IQR), mmol/L 15.4(11.7–18.2) 12.5(9.5–15.2) 18.0(14.3–21.5) 0.000 First session, median (IQR), mmol/L 6.1(2.6–7.8) 3.7(1.9–5.4) 8.3(3.4–8.6) 0.000 TC reduction, median (IQR), mmol/L 9.3(6.2–11.1) 8.8(6.3–10.6) 9.8(6.2–11.9) 0.641 Transfer/discharge, median (IQR), mmol/L 2.9(2.2–3.4) 2.5(1.9–2.8) 3.3(2.8–3.6) 0.000 HDL level Before DFPP, median (IQR), mmol/L 2.6(1.5–3.2) 1.8(1.3–2.5) 3.3(1.9–4.4) 0.005 First session, median (IQR), mmol/L 1.2(0.7–1.3) 0.9(0.6–0.9) 1.6(0.7–1.8) 0.027 HDL reduction, median (IQR), mmol/L 1.3(0.4–1.9) 1.0(0.4–1.6) 1.7(0.3–2.9) 0.081 Transfer/discharge, median (IQR), mmol/L 0.7(0.5–0.9) 0.7(0.5–0.9) 0.76(0.6–0.9) 0.466 LDL level Before DFPP, median (IQR), mmol/L 4.3(3.2-5.0) 3.8(2.6–4.8) 4.9(4.0–6.0) 0.008 First session, median (IQR), mmol/L 2.2(1.1–2.9) 1.5(0.8–2.2) 2.8(1.6–3.5) 0.001 LDL reduction, median (IQR), mmol/L 2.2(1.3–3.1) 2.2(1.4–3.1) 2.1(1.2–3.2) 0.607 Transfer/discharge, median (IQR), mmol/L 1.3(0.9–1.5) 1.1(0.7–1.4) 1.5(1.1–1.8) 0.007 Clinical results and costs Table 3 summarizes the main clinical outcomes and costs. The APACHE II score reduction was more obvious in the higher TG group, revealing a significant difference ( P < 0.05). Other clinical outcomes, including the local complication rate and SOFA score, exhibited no difference between the two groups. No statistically significant differences existed in terms of ICU and hospital stays ( P > 0.05). Except for material fees ( P < 0.05), there were no notable differences in hospital charges. Table 3 Clinical results and costs Variables All patients ( n = 50) Lower group ( n = 24) Higher group ( n = 26) P Clinical outcome After-APACHE II score, median (IQR) 4.1(2.0-5.3) 4.8(2.0-5.8) 3.5(1.0-4.5) 0.185 After-SOFA, median (IQR) 1.76(0.0-2.3) 1.9(0.0–3.0) 1.7(0.0–2.0) 0.834 APACHE II reduction, median (IQR) 7.4(5.0–10.0) 5.1(3.0-7.5) 9.5(7.0–12.0) 0.000 SOFA reduction, median (IQR) 1.3(0.0–3.0) 1.3(0.0–3.0) 1.35(0.0–3.0) 0.875 Local complication, n (%) 5(10%) 2(8.3) 3(11.5) 0.709 Mortality, n (%) 2(4%) 1(4.2) 1(3.8) 0.954 ICU stay, median (IQR), d 4.1(2.0–4.0) 4.3(1.3-4.0) 3.9(2.0–4.0) 0.245 Hospital stay, median (IQR), d 15.5(9.0-17.3) 15.6(7.3–21.3) 15.4(10.8–17.3) 0.180 Cost Total fee, median (IQR), CNY 75871.1(30997.3-69063.3) 89243.1(28527.8-80806.5) 63527.7(41335.8-69063.3) 0.156 Professional fee, median (IQR), CNY 26542.8(12746.3-24366.3) 30036.5(12688.8-30591.5) 23317.8(13170.5-22648.3) 0.485 Non-professional fee, median (IQR), CNY 49328.3(17872.3-48537.8) 59206.6(16703.5-50513.5) 40209.9(24566.8-48537.8) 0.103 Medication fee, median (IQR), CNY 33658.2(8791.0-26805.0) 43837.2(7092.0-36378.8) 24262.3(11463.3-26405.3) 0.303 Material fee, median (IQR), CNY 15670.0(7967.8-17192.0) 15369.4(6940.0-16219.0) 15947.6(11444.3-17528.3) 0.019 Association between APACHE II score and lipid profile changes Linear regression analysis was performed to reveal the relationship between APACHE II score and lipid profile alterations. The results demonstrated that clinical improvement was statistically associated with alterations in TG and TC levels in the higher TG group ( P = 0.014, P = 0.010). However, the relationship was not obvious in the lower TG group (Table 4). Table 4 Linear regression analysis of APACHE II score and lipid profile changes Variables Group β 95%CI P Lower Upper TG Lower 0.043 -0.016 0.192 0.554 Higher -0.112 -0.198 -0.025 0.014 TC Lower 0.338 -0.374 1.051 0.333 Higher 0.620 0.163 1.077 0.010 HDL Lower 0.441 -1.294 2.176 0.601 Higher -0.436 -0.972 0.100 0.106 LDL Lower -0.918 -2.496 0.659 0.238 Higher -0.880 -2.015 0.254 0.121 Discussion The goal of this study was to explore the changes in the lipid profile following DFPP and how they were related to clinical results in sHTGP patients. It is generally recognized that a higher TG level correlates with illness severity( 4 ), so timely lowering of the lipid profile is a critical goal. To compensate for the slow effect of pharmacological therapies, DFPP was performed in sHTGP patients and has been proven effective for decades. The efficacy of DFPP was tested in 47 sHTGP patients by Zheng et al., who discovered that the parameters were altered dramatically on the first day after DFPP( 5 ). This study revealed similar results, and the effect was maintained until discharge. Despite its well-known TG-lowering efficacy, DFPP is not the recommended extracorporeal therapy in the guideline of the American Society for Apheresis( 6 ). The potential mechanism of DFPP modulation in sHTGP is still unclear. Free fatty acids, identified as a critical mediator of organ failure, could not be removed by DFPP( 7 ). However, DFPP could rapidly eliminate TG lipoproteins, theoretically limiting the accumulation of free fatty acid metabolized from TG. Elevated TG levels have been independently and proportionally associated with persistent organ failure( 8 ). Consequently, the efficacy of DFPP in intervening in disease severity and clinical results in sHTGP patients has yet to be confirmed. Lu et al. conducted a propensity score matching analysis of DFPP and conservative treatment( 9 ). They found that early implementation of DFPP could effectively reduce TG levels while manifesting no benefit on the clinical results of sHTGP patients. In this study, the TG levels on admission were 39.7 mmol/L and 31.1 mmol/L in the two groups. In the other study, Chang et al. reported that DFPP could eliminate inflammatory and oxidized lipoproteins and significantly reduce the incidence of complications when applied to patients with TG levels > 56.5 mmol/L (5000 mg/dL) ( 10 ). A TG level higher than the current TG standard could be a better indication for DFPP and a better predictor of clinical outcomes. This hypothesis was partly verified by our research. The APACHE II score change was more obvious in the higher TG group than in the lower TG group, with a significant difference ( P < 0.05). This clinical improvement was related to TG and TC reductions, according to linear regression analysis, but the potential mechanism required more investigation. Moreover, it was controversial whether performing DFPP was associated with shortening hospital durations in previous studies( 10 ). In Lu’s study, DFPP imposed no effect on the length of hospital stay. However, Chang et al. inferred that DFPP could shorten the disease course and reduce hospital duration. This outcome was partly associated with the clinical improvement discussed above. In our study, the ICU and hospital stays in both groups were not significantly different (P = 0.245 and 0.180, respectively), contrary to previous expectations( 11 ). Furthermore, due to the extra expenses, DFPP was reported to increase the hospital charges( 9 ). However, except for material fees related to DFPP ( P = 0.019, < 0.05), hospital expenses were not significantly different, including total, professional, nonprofessional, and medication fees. As mentioned above, it was reasonable to infer that DFPP could offset costs by alleviating disease severity and shortening the course of illness. Limitations This was one of the largest studies to evaluate the efficacy and cost of DFPP in sHTGP patients. However, this study possessed several shortcomings. First, some latent and confounding factors might exist in this retrospective observational study, which could influence patient outcomes. Second, relatively small sample sizes from a single center undermined the ability to measure some clinical results and reveal relationships. Therefore, further large-scale and multicenter prospective studies and randomized clinical trials are needed. Conclusions DFPP can rapidly and effectively reduce lipid profile, especially TG, to target levels. Early initiation of DFPP was associated with a decrease in the APACHE II score in patients with TGs ≥ 33.9 mmol/L. Although adding an extra material fee, DFPP may not increase the total hospital expense. DFPP may have beneficial effects on sHTGP patients with a TG level higher than the current threshold. Further studies are required to confirm the value of DFPP in the management of sHTGP. Abbreviations DFPP Double filtration plasmapheresis sHTGP severe Hypertriglyceridemia-induced pancreatitis AP Acute pancreatitis TG Triglyceride BMI Body mass index SOFA Sequential Organ Failure Assessment APACHE II Acute Physiology and Chronic Health Evaluation II TC Total cholesterol LDL Low-density lipoprotein HDL High-density lipoprotein IQR Interquartile range ICU Intensive care unit Declarations This study was reported based on STROBE checklist. Ethics approval and consent to participate The research was in compliance with the Declaration of Helsinki. Ethical approval was obtained from the Second Affiliated Hospital of Zhejiang University Medical School (ID: 20220039) and the necessity for informed consent was waived. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Emails could be sent to the address below to obtain the shared data: [email protected] Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors' contributions The study was designed by Xin Xu; Pan Han was responsible for analyzing the data and drafting the manuscript; The manuscript was reviewed by Chenyang Gao. All authors read and approved the final manuscript. Acknowledgements Not applicable References Goyal H, Smith B, Bayer C, Rutherford C, Shelnut D. Differences in Severity and Outcomes Between Hypertriglyceridemia and Alcohol-Induced Pancreatitis. N Am J Med Sci. 2016;8(2):82-7. Yang AL, McNabb-Baltar J. Hypertriglyceridemia and acute pancreatitis. Pancreatology. 2020;20(5):795-800. Stefanutti C, Labbadia G, Morozzi C. Severe hypertriglyceridemia-related acute pancreatitis. Ther Apher Dial. 2013;17(2):130-7. Scherer J, Singh VP, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol. 2014;48(3):195-203. Zheng H, Wang D, Wang X, Lin Y, Lu Z, Chen Y, et al. Dynamic changes of lipid profile in severe hypertriglyceridemia-induced acute pancreatitis patients under double filtration plasmapheresis: a retrospective observational study. Lipids Health Dis. 2020;19(1):206. Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019;34(3):171-354. de Oliveira C, Khatua B, Noel P, Kostenko S, Bag A, Balakrishnan B, et al. Pancreatic triglyceride lipase mediates lipotoxic systemic inflammation. J Clin Invest. 2020;130(4):1931-47. Nawaz H, Koutroumpakis E, Easler J, Slivka A, Whitcomb DC, Singh VP, et al. Elevated serum triglycerides are independently associated with persistent organ failure in acute pancreatitis. Am J Gastroenterol. 2015;110(10):1497-503. Lu Z, Chen Y, Wu Y, Lin Y, Yang N, Wang X, et al. The role of double filtration plasmapheresis in hypertriglyceridemic pancreatitis: A propensity score matching analysis. J Clin Apher. 2020;35(5):388-97. Chang CT, Tsai TY, Liao HY, Chang CM, Jheng JS, Huang WH, et al. Double Filtration Plasma Apheresis Shortens Hospital Admission Duration of Patients With Severe Hypertriglyceridemia-Associated Acute Pancreatitis. Pancreas. 2016;45(4):606-12. Mosztbacher D, Hanak L, Farkas N, Szentesi A, Miko A, Bajor J, et al. Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases. Pancreatology. 2020;20(4):608-16. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1429591","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":90946482,"identity":"a11a7348-c542-4377-8258-f3a900b557cb","order_by":0,"name":"Pan Han","email":"","orcid":"","institution":"Second Affiliated Hospital of Zhejiang University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Pan","middleName":"","lastName":"Han","suffix":""},{"id":90946483,"identity":"703ab2e9-6f45-49f5-a1f3-97c141ae2141","order_by":1,"name":"Chenyang Gao","email":"","orcid":"","institution":"Second Affiliated Hospital of Zhejiang University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chenyang","middleName":"","lastName":"Gao","suffix":""},{"id":90946485,"identity":"b984e7c2-83f6-45f7-b518-82fab409dcf7","order_by":2,"name":"Xin Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYLACxgYJBgb2BgYDMJt4LTwHSNMCJCQSEGy8QH5G8jHJnzss5A1uPn9QzMNgI7vhAPOzB3gtmJGWJiF5RsJww+2EBGMehjTjDQfYzA3waWGWyDGTMGyTSDC4nXAAqOVw4oYDPGwS+LSwSeR/k0gEabl5sAGo5T9hLTwSOWwSB0FabjAzALUcIKxFgueZsWVjm4ThzDNpDIZzDJKNZx5mM8OrRb49+eHNn2118nzHjz8zeFNhJ9t3vPkZXi0MAgksMAVsBuDIZMarHgj4DzB/gDKZHxBSPApGwSgYBSMTAADkz0We0MJixgAAAABJRU5ErkJggg==","orcid":"","institution":"Second Affiliated Hospital of Zhejiang University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2022-03-08 05:44:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1429591/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1429591/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":19345931,"identity":"6211a3ac-4561-4f5d-93f6-2d2227c848bb","added_by":"auto","created_at":"2022-03-17 19:05:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70871,"visible":true,"origin":"","legend":"\u003cp\u003eThe study population was presented in the flow diagram. AP, acute pancreatitis; HTGP, hypertriglyceridemic-induced pancreatitis; TG, triglyceride\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-1429591/v1/e73745c97f53b3bf36a83b05.png"},{"id":19345770,"identity":"4e94b52d-be9a-4be9-9fa2-c9b6a14513bb","added_by":"auto","created_at":"2022-03-17 19:02:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":241097,"visible":true,"origin":"","legend":"\u003cp\u003eLipid profile changes before DFPP, after the first session, and on transfer/discharge. The difference between the neighboring two sets of data was investigated by T-test.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-1429591/v1/0f19381eb82baa28eb9e0594.png"},{"id":19919192,"identity":"1802463a-5996-45e5-a4aa-ecad69e5d517","added_by":"auto","created_at":"2022-04-04 06:44:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":590162,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1429591/v1/6c20101c-a388-4d5f-b3be-07b2be17ba4d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Efficacy and cost of double filtration plasmapheresis in severe hypertriglyceridemia-induced pancreatitis: A retrospective observational study","fulltext":[{"header":"Background","content":"\u003cp\u003eAcute pancreatitis (AP) is a life-threatening disease resulting from various potential etiologies. Hypertriglyceridemia is the third leading cause of AP,\u0026nbsp;accounting for approximately\u0026nbsp;7% of all cases. Severe hypertriglyceridemia-induced pancreatitis (sHTGP) differs from other causes\u0026nbsp;due to\u0026nbsp;its worse clinical course and outcomes(1). Severe hypertriglyceridemia, characterized by\u0026nbsp;a\u0026nbsp;triglyceride (TG)\u0026nbsp;level \u0026ge;11.3 mmol/L, is thought to trigger sHTGP. The pathophysiology of sHTGP is presumed to\u0026nbsp;involve\u0026nbsp;lipotoxicity of TG breakdown and activation of the inflammatory response, and the severity and clinical course are associated with these mechanisms(2). Therefore, the primary management\u0026nbsp;is\u0026nbsp;to immediately decrease the TG level to the target of 5.65 mmol/L.\u003c/p\u003e\n\u003cp\u003eExtracorporeal apheresis is an effective option for sHTGP patients, which can eliminate cytokines and proinflammatory markers and improve clinical symptoms, morbidity, and mortality(3). Double filtration plasmapheresis (DFPP) is a selective plasma component separation therapy based on a two-type filter system that can also have a triglyceride-lowering effect. DFPP is the main modality in our center, resulting from the shortage of plasma and the desire to avoid transfusion adverse effects. To date, the efficacy and cost of DFPP for sHTGP patients is still controversial. The goals of this study were to describe lipid profile alterations after DFPP in sHTGP patients and to explore the relationship between these alterations and clinical improvement.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis retrospective observational study was approved by the ethics committee.\u003c/p\u003e\n\u003cp\u003ePatients\u003c/p\u003e\n\u003cp\u003eThis study was conducted in the\u0026nbsp;Department\u0026nbsp;of General ICU from January 2016 to December 2021. Patients were recruited once AP was identified. Age \u0026lt; 18 years, pregnancy, other etiologies of AP, TG level＜11.3 mmol/L, contraindication for DFPP, and incomplete data were the exclusion criteria.\u003c/p\u003e\n\u003ch2\u003eDFPP\u003c/h2\u003e\n\u003cp\u003eDFPP was conducted by\u0026nbsp;a\u0026nbsp;Plasauto\u0026Sigma;\u0026trade; (Asahi Kasei, Japan) equipped with\u0026nbsp;a\u0026nbsp;plasma separator (Plasmaflo\u0026trade; OP-08) and plasma component separator (Cascadeflo\u003csup\u003eTM\u003c/sup\u003e EC-50 W). Vascular access was mostly through the femoral vein. An average of 1.5-time plasma volume was processed. The blood flow rate, plasma separation rate, and discarding rate were\u0026nbsp;100 mL/min, 20%, and 10%, respectively. Heparin was\u0026nbsp;administered\u0026nbsp;for anticoagulation during the entire procedure. Once\u0026nbsp;the\u0026nbsp;TG level (\u0026lt;5.6 mmol/L) was achieved, no additional sessions\u0026nbsp;were\u0026nbsp;delivered.\u003c/p\u003e\n\u003ch2\u003eData collection\u003c/h2\u003e\n\u003cp\u003eElectronic medical records were reviewed for baseline characteristics,\u0026nbsp;including demographic data, body mass index (BMI),\u0026nbsp;comorbidities, time from onset to admission, BISAP score, Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The lipid profile,\u0026nbsp;including\u0026nbsp;TG, total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), was collected before DFPP, after the first session, and\u0026nbsp;upon\u0026nbsp;transfer/discharge. Clinical outcomes were depicted by APACHE II and SOFA\u0026nbsp;scores\u0026nbsp;after all sessions, local complications, mortality, and length of ICU and hospital stays. Hospital expenses were divided into total\u0026nbsp;fees, professional fees and\u0026nbsp;nonprofessional fees, and the latter item was divided into medication and material\u0026nbsp;fees.\u003c/p\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003ePatients were divided into higher and lower TG groups based on the TG level of 33.9 mmol/L\u0026nbsp;(3 times the upper limit). Continuous variables with\u0026nbsp;a\u0026nbsp;normal distribution were described as\u0026nbsp;the\u0026nbsp;mean \u0026plusmn; SD and\u0026nbsp;were\u0026nbsp;analyzed by t-test, while continuous variables with\u0026nbsp;a nonnormal\u0026nbsp;distribution were reported as\u0026nbsp;the\u0026nbsp;median (interquartile range) and\u0026nbsp;were\u0026nbsp;analyzed using the Mann\u0026ndash;Whitney test. The association between lipid profile and APACHE II score changes was revealed using linear regression analysis. \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 was judged to indicate statistical significance. Data were analyzed using SPSS 24.0 and GraphPad Prism 9.0.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003ePatient characteristics\u003c/h2\u003e\n\u003cp\u003eDuring this investigation, 63 patients were admitted and diagnosed with AP. Fifty sHTGP patients were recruited after exclusions (Fig.\u0026nbsp;1). The baseline characteristics are described in Table\u0026nbsp;1. The mean age was 37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5 years (range: 21\u0026ndash;65 years), and 39 (78.0%) patients were men. The average number of days from disease onset to admission were 1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 d. Sixteen (32.0%) patients had recurrent AP, and 20 (40.0%) patients had a past medical history of hyperlipidemia. Thirty (60.0%) patients were complicated with various risk factors, including diabetes (28.0%), alcohol abuse (24.0%) and medication history (26.0%). On admission, the average APACHE II score in the higher TG group was significantly higher than that in the lower TG group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eBaseline characteristics of the patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll patients\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower group\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigher group\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, median (IQR), y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.7(29.8\u0026ndash;44.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.0(28.0-43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.4(30.8\u0026ndash;44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (78.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18(69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.628\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecurrence, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.848\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreexisting comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHyperlipidemia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.653\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlcohol abuse, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedication, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnset to admission, median (IQR), d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2(0.7-2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3(1.0\u0026ndash;2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.2(0.58\u0026ndash;1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisease severity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBISAP score, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1(2.0\u0026ndash;2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.0(2.0\u0026ndash;2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.15(2.0\u0026ndash;2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore-APACHE II score, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.5(7.0\u0026ndash;14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.9(6.0-12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0(9.0-17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore-SOFA, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1(1.0\u0026ndash;4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1(1.3\u0026ndash;4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.0(1.0\u0026ndash;4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003eLipid profile changes\u003c/h2\u003e\n\u003cp\u003eIn addition to adjunctive therapy, all patients underwent DFPP within 24 hours of admission without any complications. The majority of patients (n\u0026thinsp;=\u0026thinsp;46, 92.0%) received fewer than 3 sessions, with 26 (52.0%) patients receiving only one session. Patients in the higher TG group experienced more sessions than those in the lower TG group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The lipid profile presented a distinct difference after DFPP and remained stable (Fig.\u0026nbsp;2). The TG level was remarkably reduced by 71.9% on average (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and the levels of TC, HDL, and LDL all synchronously decreased (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Compared to the lower TG group, DFPP generated a stronger TG-lowering effect in the higher TG group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) after the first session but there were no significant differences in TC, HDL, or LDL levels (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eTherapy and lipid profile changes\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll patients\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower group\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigher group\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSession, median (IQR), n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.6(1.0\u0026ndash;2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3(1.0-1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.8(1.0\u0026ndash;2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdjunctive therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSomatostatin, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46(92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25(96.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.265\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsulin, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26(52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFibrate, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41(82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22(84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTG level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore DFPP, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44.2(23.8\u0026ndash;63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.3(19.2\u0026ndash;30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.6(42.2\u0026ndash;75.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst session, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.4(3.0-16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.0(2.7\u0026ndash;5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.3(4.8\u0026ndash;21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTG reduction, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.8(18.8\u0026ndash;42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.3(13.8\u0026ndash;26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44.3(33.8\u0026ndash;53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransfer/discharge, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.7(2.7\u0026ndash;4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3(2.6\u0026ndash;4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.0(3.3\u0026ndash;4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTC level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore DFPP, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.4(11.7\u0026ndash;18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.5(9.5\u0026ndash;15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.0(14.3\u0026ndash;21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst session, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.1(2.6\u0026ndash;7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7(1.9\u0026ndash;5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.3(3.4\u0026ndash;8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTC reduction, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.3(6.2\u0026ndash;11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.8(6.3\u0026ndash;10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.8(6.2\u0026ndash;11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.641\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransfer/discharge, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.9(2.2\u0026ndash;3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5(1.9\u0026ndash;2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.3(2.8\u0026ndash;3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHDL level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore DFPP, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.6(1.5\u0026ndash;3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8(1.3\u0026ndash;2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.3(1.9\u0026ndash;4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst session, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.2(0.7\u0026ndash;1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9(0.6\u0026ndash;0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.6(0.7\u0026ndash;1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHDL reduction, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.3(0.4\u0026ndash;1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0(0.4\u0026ndash;1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.7(0.3\u0026ndash;2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransfer/discharge, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7(0.5\u0026ndash;0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7(0.5\u0026ndash;0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.76(0.6\u0026ndash;0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLDL level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore DFPP, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.3(3.2-5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8(2.6\u0026ndash;4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.9(4.0\u0026ndash;6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst session, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.2(1.1\u0026ndash;2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5(0.8\u0026ndash;2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8(1.6\u0026ndash;3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLDL reduction, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.2(1.3\u0026ndash;3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2(1.4\u0026ndash;3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.1(1.2\u0026ndash;3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransfer/discharge, median (IQR), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.3(0.9\u0026ndash;1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1(0.7\u0026ndash;1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.5(1.1\u0026ndash;1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003eClinical results and costs\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;3 summarizes the main clinical outcomes and costs. The APACHE II score reduction was more obvious in the higher TG group, revealing a significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Other clinical outcomes, including the local complication rate and SOFA score, exhibited no difference between the two groups. No statistically significant differences existed in terms of ICU and hospital stays (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Except for material fees (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), there were no notable differences in hospital charges.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eClinical results and costs\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll patients\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower group\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigher group\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClinical outcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter-APACHE II score, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1(2.0-5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8(2.0-5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.5(1.0-4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter-SOFA, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.76(0.0-2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.9(0.0\u0026ndash;3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7(0.0\u0026ndash;2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.834\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAPACHE II reduction, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.4(5.0\u0026ndash;10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.1(3.0-7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.5(7.0\u0026ndash;12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSOFA reduction, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3(0.0\u0026ndash;3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3(0.0\u0026ndash;3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.35(0.0\u0026ndash;3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.875\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLocal complication, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMortality, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.954\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eICU stay, median (IQR), d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1(2.0\u0026ndash;4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.3(1.3-4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.9(2.0\u0026ndash;4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospital stay, median (IQR), d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.5(9.0-17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.6(7.3\u0026ndash;21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.4(10.8\u0026ndash;17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal fee, median (IQR), CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75871.1(30997.3-69063.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89243.1(28527.8-80806.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63527.7(41335.8-69063.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional fee, median (IQR), CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26542.8(12746.3-24366.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30036.5(12688.8-30591.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23317.8(13170.5-22648.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-professional fee, median (IQR), CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49328.3(17872.3-48537.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59206.6(16703.5-50513.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40209.9(24566.8-48537.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedication fee, median (IQR), CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33658.2(8791.0-26805.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43837.2(7092.0-36378.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24262.3(11463.3-26405.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaterial fee, median (IQR), CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15670.0(7967.8-17192.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15369.4(6940.0-16219.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15947.6(11444.3-17528.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003eAssociation between APACHE II score and lipid profile changes\u003c/h2\u003e\n\u003cp\u003eLinear regression analysis was performed to reveal the relationship between APACHE II score and lipid profile alterations. The results demonstrated that clinical improvement was statistically associated with alterations in TG and TC levels in the higher TG group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010). However, the relationship was not obvious in the lower TG group (Table\u0026nbsp;4).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eLinear regression analysis of APACHE II score and lipid profile changes\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.333\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eLDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.496\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe goal of this study was to explore the changes in the lipid profile following DFPP and how they were related to clinical results in sHTGP patients. It is generally recognized that a higher TG level correlates with illness severity(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), so timely lowering of the lipid profile is a critical goal. To compensate for the slow effect of pharmacological therapies, DFPP was performed in sHTGP patients and has been proven effective for decades. The efficacy of DFPP was tested in 47 sHTGP patients by Zheng et al., who discovered that the parameters were altered dramatically on the first day after DFPP(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This study revealed similar results, and the effect was maintained until discharge.\u003c/p\u003e \u003cp\u003eDespite its well-known TG-lowering efficacy, DFPP is not the recommended extracorporeal therapy in the guideline of the American Society for Apheresis(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The potential mechanism of DFPP modulation in sHTGP is still unclear. Free fatty acids, identified as a critical mediator of organ failure, could not be removed by DFPP(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, DFPP could rapidly eliminate TG lipoproteins, theoretically limiting the accumulation of free fatty acid metabolized from TG. Elevated TG levels have been independently and proportionally associated with persistent organ failure(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Consequently, the efficacy of DFPP in intervening in disease severity and clinical results in sHTGP patients has yet to be confirmed. Lu et al. conducted a propensity score matching analysis of DFPP and conservative treatment(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). They found that early implementation of DFPP could effectively reduce TG levels while manifesting no benefit on the clinical results of sHTGP patients. In this study, the TG levels on admission were 39.7 mmol/L and 31.1 mmol/L in the two groups. In the other study, Chang et al. reported that DFPP could eliminate inflammatory and oxidized lipoproteins and significantly reduce the incidence of complications when applied to patients with TG levels\u0026thinsp;\u0026gt;\u0026thinsp;56.5 mmol/L (5000 mg/dL) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). A TG level higher than the current TG standard could be a better indication for DFPP and a better predictor of clinical outcomes. This hypothesis was partly verified by our research. The APACHE II score change was more obvious in the higher TG group than in the lower TG group, with a significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This clinical improvement was related to TG and TC reductions, according to linear regression analysis, but the potential mechanism required more investigation.\u003c/p\u003e \u003cp\u003eMoreover, it was controversial whether performing DFPP was associated with shortening hospital durations in previous studies(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In Lu\u0026rsquo;s study, DFPP imposed no effect on the length of hospital stay. However, Chang et al. inferred that DFPP could shorten the disease course and reduce hospital duration. This outcome was partly associated with the clinical improvement discussed above. In our study, the ICU and hospital stays in both groups were not significantly different (P\u0026thinsp;=\u0026thinsp;0.245 and 0.180, respectively), contrary to previous expectations(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Furthermore, due to the extra expenses, DFPP was reported to increase the hospital charges(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, except for material fees related to DFPP (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019, \u0026lt;\u0026thinsp;0.05), hospital expenses were not significantly different, including total, professional, nonprofessional, and medication fees. As mentioned above, it was reasonable to infer that DFPP could offset costs by alleviating disease severity and shortening the course of illness.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThis was one of the largest studies to evaluate the efficacy and cost of DFPP in sHTGP patients. However, this study possessed several shortcomings. First, some latent and confounding factors might exist in this retrospective observational study, which could influence patient outcomes. Second, relatively small sample sizes from a single center undermined the ability to measure some clinical results and reveal relationships. Therefore, further large-scale and multicenter prospective studies and randomized clinical trials are needed.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDFPP can rapidly and effectively reduce lipid profile, especially TG, to target levels. Early initiation of DFPP was associated with a decrease in the APACHE II score in patients with TGs\u0026thinsp;\u0026ge;\u0026thinsp;33.9 mmol/L. Although adding an extra material fee, DFPP may not increase the total hospital expense. DFPP may have beneficial effects on sHTGP patients with a TG level higher than the current threshold. Further studies are required to confirm the value of DFPP in the management of sHTGP.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDFPP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDouble filtration plasmapheresis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003esHTGP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esevere Hypertriglyceridemia-induced pancreatitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute pancreatitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTriglyceride\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSOFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSequential Organ Failure Assessment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAPACHE II\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute Physiology and Chronic Health Evaluation II\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal cholesterol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLDL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-density lipoprotein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHDL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigh-density lipoprotein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive care unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eThis study was reported based on\u0026nbsp;STROBE\u0026nbsp;checklist.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe research was in compliance with the Declaration of Helsinki. Ethical approval was obtained from the Second Affiliated Hospital of Zhejiang University Medical School (ID: 20220039) and the necessity for informed consent was waived.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Emails could be sent to the address below to obtain the shared data: [email protected]\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eThe study was designed by Xin Xu; Pan Han was responsible for analyzing the data and drafting the manuscript; The manuscript was reviewed by Chenyang Gao. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGoyal H, Smith B, Bayer C, Rutherford C, Shelnut D. Differences in Severity and Outcomes Between Hypertriglyceridemia and Alcohol-Induced Pancreatitis. N Am J Med Sci. 2016;8(2):82-7.\u003c/li\u003e\n\u003cli\u003eYang AL, McNabb-Baltar J. Hypertriglyceridemia and acute pancreatitis. Pancreatology. 2020;20(5):795-800.\u003c/li\u003e\n\u003cli\u003eStefanutti C, Labbadia G, Morozzi C. Severe hypertriglyceridemia-related acute pancreatitis. Ther Apher Dial. 2013;17(2):130-7.\u003c/li\u003e\n\u003cli\u003eScherer J, Singh VP, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol. 2014;48(3):195-203.\u003c/li\u003e\n\u003cli\u003eZheng H, Wang D, Wang X, Lin Y, Lu Z, Chen Y, et al. Dynamic changes of lipid profile in severe hypertriglyceridemia-induced acute pancreatitis patients under double filtration plasmapheresis: a retrospective observational study. Lipids Health Dis. 2020;19(1):206.\u003c/li\u003e\n\u003cli\u003ePadmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019;34(3):171-354.\u003c/li\u003e\n\u003cli\u003ede Oliveira C, Khatua B, Noel P, Kostenko S, Bag A, Balakrishnan B, et al. Pancreatic triglyceride lipase mediates lipotoxic systemic inflammation. J Clin Invest. 2020;130(4):1931-47.\u003c/li\u003e\n\u003cli\u003eNawaz H, Koutroumpakis E, Easler J, Slivka A, Whitcomb DC, Singh VP, et al. Elevated serum triglycerides are independently associated with persistent organ failure in acute pancreatitis. Am J Gastroenterol. 2015;110(10):1497-503.\u003c/li\u003e\n\u003cli\u003eLu Z, Chen Y, Wu Y, Lin Y, Yang N, Wang X, et al. The role of double filtration plasmapheresis in hypertriglyceridemic pancreatitis: A propensity score matching analysis. J Clin Apher. 2020;35(5):388-97.\u003c/li\u003e\n\u003cli\u003eChang CT, Tsai TY, Liao HY, Chang CM, Jheng JS, Huang WH, et al. Double Filtration Plasma Apheresis Shortens Hospital Admission Duration of Patients With Severe Hypertriglyceridemia-Associated Acute Pancreatitis. Pancreas. 2016;45(4):606-12.\u003c/li\u003e\n\u003cli\u003eMosztbacher D, Hanak L, Farkas N, Szentesi A, Miko A, Bajor J, et al. Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases. Pancreatology. 2020;20(4):608-16.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Double filtration plasmapheresis, acute hypertriglyceridemia-induced pancreatitis, clinical results, costs","lastPublishedDoi":"10.21203/rs.3.rs-1429591/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1429591/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe value of double filtration plasmapheresis (DFPP) in severe hypertriglyceridemia-induced pancreatitis (sHTGP) is controversial. This study aimed to investigate the efficacy of DFPP on clinical results in patients with sHTGP and the costs associated with the procedure.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePatients who underwent DFPP after admission between January 2016 and December 2021 were recruited. Data on lipid profile, clinical results, and costs were retrospectively collected and analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFifty sHTGP patients who received DFPP were enrolled. All of the lipid profile were significantly reduced and maintained a downward trend. The APACHE II score on admission was higher and the reduction after DFPP was more obvious (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in patients with higher triglyceride (TG) levels (\u0026ge;\u0026thinsp;33.9 mmol/L) than in patients with lower TG levels. More material fees were expended in the higher TG group due to more DFPP sessions (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but no significant differences existed in total hospital costs between the two groups.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDFPP could rapidly and effectively reduce TGs to a safe level. APACHE II score reduction was obvious in patients with TGs\u0026thinsp;\u0026ge;\u0026thinsp;33.9 mmol/L and was associated with lipid profile changes. DFPP may benefit sHTGP patients with a TG level higher than the current initiation threshold.\u003c/p\u003e","manuscriptTitle":"Efficacy and cost of double filtration plasmapheresis in severe hypertriglyceridemia-induced pancreatitis: A retrospective observational study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-03-17 19:02:47","doi":"10.21203/rs.3.rs-1429591/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dc35428c-3160-42e3-b960-4f354d54847b","owner":[],"postedDate":"March 17th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-04-04T06:44:14+00:00","versionOfRecord":[],"versionCreatedAt":"2022-03-17 19:02:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1429591","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1429591","identity":"rs-1429591","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}