Continuous intravenous infusion of insulin and heparin vs plasma exchange in hypertriglyceridemia-induced acute pancreatitis

Objective: Acute triglyceride-lowering therapy is crucial in the early treatment of hypertriglyceridemia-induced pancreatitis. This study aimed to compare the efficacy of continuous i.v. infusion of insulin and heparin therapy (IHT) and plasma exchange to lower triglyceride levels in the acute phase of hypertriglyceridemia-induced pancreatitis.

Methods: A retrospective observational study was conducted in a tertiary teaching hospital. Patients with hypertriglyceridemia-induced pancreatitis were consecutively enrolled from 2012 to 2017. Serum triglyceride levels and clinical data during hospitalization were collected. The primary outcome was the rapid reduction of triglyceride levels.

Results: Of the 62 patients enrolled, 34 (54.8%) were treated with IHT and the others with plasma exchange. A reduced triglyceride level of (66.9 ± 21.5)% after the first plasma exchange session and that of (75.0 ± 14.6)% after the first day of IHT were observed. There were no significant differences in the reduction of triglyceride (F = 0.334), high sensitivity C-reactive protein (F = 0.127) and the acute physiology and chronic health evaluation II score (F = 2.589) between the two groups (all P > 0.05). The medical cost during hospitalization was significantly lower in the IHT group than in the plasma exchange group (RMB [59 512.4 ± 23 645.1] vs RMB [89 461.9 ± 48 324.0], P < 0.05). Adverse effects were observed in six patients in the plasma exchange group but none in the IHT group.

Conclusion: As a minimally invasive and economical strategy, IHT is effective and non-inferior to plasma exchange in achieving a rapid reduction of triglyceride levels.