Clinical outcomes of lipid apheresis in hypertriglyceridemia-induced acute pancreatitis: A 10-year triglyceride-stratified retrospective study

BACKGROUND: Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) has become the second leading cause of acute pancreatitis in China, accounting for approximately 20% of cases. Although lipid apheresis (LA) reduces triglyceride (TG) levels, its clinical utility and patient selection criteria remain unclear. OBJECTIVE: This study aimed to evaluate LA outcomes in patients with HTG-AP, comparing outcomes between those with baseline TG levels of 22.4 to 56.5 mmol/L and >56.5 mmol/L. METHODS: This was a single-center retrospective cohort study utilizing data from the electronic medical records of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (from January 2014 to August 2024). RESULTS: A total of 608 patients with HTG-AP were included, of whom 123 underwent LA. After propensity score matching, 65 matched pairs were included. Generalized linear model analysis showed that LA was significantly associated with higher odds of intensive care unit (ICU) admission (β = 2.49, P < .01). The LA group had higher TG levels (β = 0.48, P < .01) and higher Acute Physiology and Chronic Health Evaluation II scores on day 3 (β = 0.16, P = .047). No significant differences were observed in C-reactive protein, systemic inflammatory response syndrome, computed tomography severity index, or sequential organ failure assessment scores. Among LA-treated patients, those with baseline TG >56.5 mmol/L had a significantly higher likelihood of prolonged hospitalization (length of stay >14 days) compared with the 22.4 to 56.5 mmol/L group (β = 1.43, P < .01). Sensitivity analyses supported the robustness of the primary results. CONCLUSION: LA therapy was associated with higher odds of ICU admission in patients with HTG-AP. Among LA-treated patients, baseline TG >56.5 mmol/L predicted prolonged hospitalization, which was supported by sensitivity analysis.