Introduction Hyperlipidemia is a major risk factor for atherosclerotic cardiovascular disease (ASCVD). Although statins are the cornerstone of lipid-lowering therapy, their use may be limited in some patients by adverse effects. This study evaluated the possible impact of non-drug treatment using double-filtration plasmapheresis (DFPP) on CD14+ monocytes and to identify alterations in plasma proteomics after DFPP in patients with hyperlipidemia.Methods Thirty-seven hyperlipidemic patients were enrolled. Mitochondria changes, lipid peroxidation, reactive oxygen species (ROS), and mitochondrial lipid peroxidation were examined. CD14+ monocyte proteins related to ferroptosis were assayed by western blotting, and plasma proteomic changes were measured by data-independent acquisition (DIA).Results In comparison to their levels prior to double-filtration plasmapheresis (DFPP), there was a notable reduction in total cholesterol (TC), total triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), lipoprotein(a) (Lp(a)), and small dense low-density lipoprotein cholesterol (sdLDL) after DFPP. DFPP may attenuate ferroptosis in peripheral blood CD14+ monocytes of patients with hyperlipidemia. Three protein candidates were identified from the DIA dataset.Conclusions DFPP exerts lipid-lowering effects in patients with hyperlipidemia. The ACSL4/LPCAT3/ALOX5 pathway and the three proteins are likely involved in alleviating ferroptosis. Trial Registration: identifier: NCT03491956Conclusions DFPP exerts lipid-lowering effects in patients with hyperlipidemia. The ACSL4/LPCAT3/ALOX5 pathway and the three proteins are likely involved in alleviating ferroptosis. Trial Registration: identifier: NCT03491956
ABSTRACT Background This study aimed to investigate the heterogeneity in the efficacy of hemoperfusion (HP) plus continuous venovenous hemofiltration (CVVH) versus CVVH alone in reducing the incidence of severe acute pancreatitis (SAP) among patients with hypertriglyceridemia‐induced acute pancreatitis (HTG‐AP), stratified by the inflammatory marker C‐reactive protein (CRP). In addition, we assessed secondary outcomes encompassing laboratory response, disease severity and organ function, healthcare resource utilization, and treatment‐related indicators, so as to delineate the broader efficacy profile of the combination therapy and its relationship with the primary endpoint. Furthermore, we sought to identify a CRP‐based therapeutic window for the combination therapy. Methods This single‐center retrospective study included 204 patients who were assigned to the HP + CVVH group ( n = 103) or the CVVH group ( n = 101). Multivariable logistic regression was used to assess the overall difference in efficacy between the two groups. Restricted cubic splines (RCS) were employed to analyze the nonlinear relationship between treatment efficacy and CRP levels and to identify a CRP‐based therapeutic window. Secondary outcomes were analyzed using multivariable logistic regression for categorical variables and generalized linear models for quantitative variables. Results After multivariable adjustment, the incidence of SAP did not differ significantly between the HP + CVVH and CVVH groups ( p > 0.05). RCS analysis revealed a significant interaction between treatment group and CRP levels. The conditional odds ratio for SAP (HP + CVVH vs. CVVH) was significantly below 1 only within a specific CRP range: 194.96–296.91 mg/L in the primary analysis and 200.77–285.81 mg/L after propensity score adjustment ( p < 0.05). Regarding secondary outcomes, HP + CVVH was associated with significantly lower CRP, procalcitonin, and triglyceride levels on day 3, more SIRS‐free days within 14 days, lower peak intra‐abdominal pressure, shorter ICU length of stay, fewer CVVH sessions, earlier initiation of enteral nutrition, and higher blood purification‐related costs (all p < 0.05). No significant differences were observed in organ failure‐free days, incidence of pancreatic necrosis, hospital length of stay, total hospitalization cost, total morphine equivalent dose, carbapenem use, or duration of mechanical ventilation (all p > 0.05). Conclusion HP + CVVH showed no overall superiority to CVVH alone in preventing SAP. Nevertheless, secondary outcome analyses demonstrated improved inflammatory control, faster resolution of systemic inflammatory response, reduced intra‐abdominal pressure, and better recovery in several resource‐related and treatment‐related indicators, indicating measurable biological and clinical process benefits. These benefits, however, did not translate into a uniform reduction in SAP. The effect of HP + CVVH on the hard endpoint was conditional, nonlinear, and dependent on baseline inflammatory burden, with significant benefit confined to a specific CRP therapeutic window. Therefore, improvements in secondary endpoints should not be equated with hard‐endpoint benefit, and the decision to initiate HP + CVVH should be individualized according to the intensity of the inflammatory response.
ABSTRACT Introduction Comparative postoperative outcomes after cardiac surgery in Japanese patients receiving peritoneal dialysis (PD) and hemodialysis (HD) remain unclear. Methods We retrospectively evaluated 26 dialysis patients who underwent cardiac surgery from 2016 to 2022. The primary endpoint was a composite of all‐cause death, ischemic stroke, bleeding complications, and infections during hospitalization. The secondary endpoints included intubation duration, intensive care unit (ICU) stay, and postoperative stay in the cardiovascular surgery department. Results Seven patients received PD and nineteen received HD. The composite outcome occurred in 14% in PD and 42% in HD patients ( p = 0.36). Median intubation duration and ICU stay were 1 vs. 2 days ( p = 0.18) and 4 vs. 4 days ( p = 0.91), respectively. Median postoperative stay was shorter in PD than HD patients (14 vs. 17 days, p = 0.03). Conclusion No statistically significant difference in the composite in‐hospital outcome was observed between groups, although estimates were imprecise because of the small sample size.
