Efficacy and adverse effects of insulin versus plasmapheresis in patients with hypertriglyceridemia-3-induced acute pancreatitis: a systematic review and meta-analysis

Shobhit Piplani; Arpit Jain; Kamaldeep Singh; Shreya Gulati; Salil Chaturvedi; Vishal Reddy Bejugam; Donclair Brown; Chisom Asuzu; Shiny Teja Kolli; Usman Shah; Jashan Reet; Milos Mihajlovic; Vladimir Jelic; Gavro Jelic; Rosalba Santana De Roberts; Dushyant Damania; Miroslav Radulovic

Authors Shobhit Piplani, Arpit Jain, Kamaldeep Singh, Shreya Gulati, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Gavro Jelic, Rosalba Santana De Roberts, Dushyant Damania, Miroslav Radulovic.

Abstract

Background Hypertriglyceridemia is a common cause of acute pancreatitis (AP). This literature review compared the effectiveness and adverse events of insulin therapy, with or without heparin, and plasmapheresis, in reducing triglyceride levels in patients with hypertriglyceridemia-induced AP.

Methods Systematic reviews, meta-analyses, evidence syntheses, editorials, commentaries, protocols, abstracts, theses and preprints were excluded. Review Manager was used to conduct the meta-analysis. The literature search yielded 2765 articles, but only 5 were included in the systematic review and meta-analysis and the total number of participants in the review was 269.

Results From this study’s analysis, insulin ± heparin was more successful in reducing triglyceride levels than plasmapheresis (standardized mean difference -0.37, 95% confidence interval [CI] 0.99 to 0.25; P=0.25). Insulin ± heparin therapy had a lower mortality rate than plasmapheresis (risk ratio [RR] 0.70, 95%CI 0.25-1.95). Hypotension, hypoglycemia, and acute renal failure were less common in the plasmapheresis therapy group than in insulin ± heparin therapy (RR 1.13, 95%CI 0.46-2.81, RR 3.90, 95%CI 0.45-33.78, and RR 0.48, 95%CI 0.02-13.98 for hypotension, hypoglycemia, and acute renal failure, respectively).

Conclusions This study found no significant difference in mortality between insulin ± heparin therapy and plasmapheresis used for the reduction in triglyceride levels. It is notable that no substantial differences were observed in the most common side-effects encountered during these therapies, thus indicating non-inferiority.

Keywords Insulin, plasmapheresis, acute pancreatitis, hypertriglyceridemia

Ann Gastroenterol 2024; 37 (1): 109-116