A recent multicenter, prospective cohort study conducted in China, known as the PERFORM study, has shed light on the importance of rapid triglyceride reduction in managing hypertriglyceridemia-induced acute pancreatitis (HTG-AP). The study, involving multiple centers within the Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG), demonstrated that achieving a target triglyceride level of ≤5.65 mmol/L within the first three days of admission is associated with improved clinical outcomes, specifically an increase in organ failure-free days (OFFD).
The study enrolled patients aged 18–70 years diagnosed with AP and admitted within 72 hours of abdominal pain onset, with plasma triglyceride levels >11.3 mmol/L at admission and at least one worrisome clinical feature such as hypocalcemia, lactic acidosis, systemic inflammatory response syndrome (SIRS), or worsening organ dysfunction. Patients received standard AP treatment, including intravenous fluids, pain control, nutritional support, and, if needed, mechanical ventilation or continuous renal replacement therapy. Triglyceride-lowering therapies, including blood purification (plasma exchange, hemoperfusion, or hemofiltration) and medical treatments (insulin and heparin), were administered at the treating physician's discretion.
The primary outcome measured was organ failure-free days (OFFD) up to day 14. Secondary outcomes included mortality by day 28, presence of organ failure at day 7, changes in SOFA scores, ICU-free days, hospital-free days, new-onset organ failure, need for blood purification and ICU admission, and incidence of infected pancreatic necrosis (IPN) by day 60.
Statistical Analysis Highlights
Researchers employed rigorous statistical methods to analyze the data. They used both a dichotomization approach (patients reaching target triglyceride levels vs. those not reaching them) and a sensitivity analysis based on the rate of triglyceride decline. Adjusted generalized linear models (GLM) were used to account for potential confounders, including age, sex, body mass index (BMI), baseline triglyceride level, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. A Fine and Gray competing risk model was used to account for mortality.
Key Findings
The study found a significant association between achieving the target triglyceride level (≤5.65 mmol/L) by day 3 and improved organ failure-free days. The researchers also performed propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses to further validate their findings regarding the impact of blood purification on clinical outcomes.
Implications for Clinical Practice
These findings underscore the importance of early and aggressive triglyceride-lowering strategies in patients with HTG-AP. While the study design allowed for physician discretion in choosing the specific triglyceride-lowering therapy, the results suggest that timely and effective intervention is crucial for improving patient outcomes. Further research is warranted to determine the optimal strategies for triglyceride reduction in this patient population.
