Emergent Triglyceride-lowering Therapy With Early High-volume Hemofiltration Against Low–Molecular-Weight Heparin Combined With Insulin in Hypertriglyceridemic Pancreatitis
| Autor: | Nong-hua Lv, Wenhua He, Yin Zhu, Liang Xia, Yong Zhu, Min Yu, Pi Liu, Hao Zeng |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class medicine.medical_treatment Low molecular weight heparin Gastroenterology law.invention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Randomized controlled trial law Internal medicine Hemofiltration Humans Insulin Medicine Prospective Studies Prospective cohort study APACHE Hypolipidemic Agents Hypertriglyceridemia Triglyceride business.industry Heparin Heparin Low-Molecular-Weight medicine.disease Combined Modality Therapy Surgery Treatment Outcome Pancreatitis chemistry 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology business medicine.drug |
| Zdroj: | Journal of Clinical Gastroenterology. 50:772-778 |
| ISSN: | 0192-0790 |
| DOI: | 10.1097/mcg.0000000000000552 |
| Popis: | To compare the value of emergent triglyceride (TG)-lowering therapies between early high-volume hemofiltration (HVHF) and low-molecular-weight heparin (LMWH) combined with insulin (LMWH+insulin) as well as their effects on the outcomes of hypertriglyceridemic pancreatitis (HTGP) patients.In this randomized controlled trial, 66 HTGP patients presenting within 3 days after the onset of symptoms from August 2011 to October 2013 were assigned randomly to receive either HVHF or LMWH+insulin as an emergent TG-lowering therapy. Thirty-three patients were included in each group, and the therapy was started as soon as possible after admission. TG levels, clinical outcomes, and inflammatory biomarkers were compared between the 2 groups.Thirty-two individuals in the HVHF group and 34 in the LMWH+insulin group were included in the final analysis. Characteristics of the patients in both groups were roughly comparable. HVHF could remove TG from the plasma and achieve its target (500 mg/dL) in approximately 9 hours, whereas the target was not achieved within 48 hours in patients receiving the LMWH+insulin treatment (P0.05). However, no differences were found in terms of the majority of the clinical outcomes, including local pancreatic complications (P0.05), the requirement of surgical intervention (P=0.49), mortality (P=0.49), and the duration of hospitalization (P=0.144). Furthermore, an unexpectedly higher incidence of persistent organ failure was observed in the HVHF group compared with the LMWH+insulin group (risk ratio with HVHF, 2.42; 95% confidence interval, 1.15-5.11; P=0.01). Hospital charges for patients in the HVHF group were approximately 2-fold higher than those for patients in the LMWH+insulin group (5.20±4.90 vs. 2.92±3.21, P=0.03). We selected a systemic inflammatory response syndrome score of at least 2 at baseline as a predictor of SAP patients, and the subgroup analyses showed that HVHF cannot improve the prognosis of the predicted SAP patients compared with the LMWH+insulin group.HVHF can lower TG levels more efficiently than LMWH+insulin therapy, but it is not superior in terms of clinical outcomes and costs. Further multicenter studies with large samples are required to clarify the feasibility of administering the HVHF treatment to HTGP patients (ChiCTR-TRC-13003274). |
| Databáze: | OpenAIRE |
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