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Article / Publication Details

First-Page Preview

Received: December 05, 2021
Accepted: May 07, 2022
Published online: July 04, 2022

Number of Print Pages: 11
Number of Figures: 2
Number of Tables: 6

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Introduction: The aim of this study was to investigate the efficacy of prolonged intermittent renal replacement therapy (PIRRT) plus hemoperfusion (HP) in treating moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). Methods: A total of 105 MSAP and SAP patients were enrolled. Sixty of them received routine internal medical therapy (control group), and 45 received PIRRT and HP in addition to routine internal medical therapy (PIRRT + HP group). The vital signs, laboratory results, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score were compared between the two groups before treatment and on the 3rd and 7th days of treatment. Results: No deaths or treatment-related serious adverse reactions occurred in both groups. After 3 and 7 days of treatment, the APACHE II score decreased more significantly in the PIRRT + HP group than in the control group (3 days: 5.47 [±3.30] vs. 7.53 [±3.89], p = 0.005. 7 days: 4.82 [±3.49] vs. 6.87 [±3.54], p = 0.004). After 3 days of treatment, the inflammatory combination parameters systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) in the PIRRT + HP group decreased more significantly than those in the control group (SII: 1,239.00 [737.80–1,769.00] vs. 2,013.00 [1,260.00–3,167.00], p = 0.001. NLR: 8.78 [±4.52] vs. 11.88 [±7.30], p = 0.009). After 7 days of treatment, SII, NLR, and hypersensitive C-reactive protein decreased significantly compared with baseline, but no statistical differences between the two groups were observed. AST in both groups remained stable with treatment. There was no significant difference in baseline creatinine between the two groups of AKI patients, but after 3 and 7 days of treatment, the proportion of acute kidney injury (AKI) patients in the PIRRT + HP group whose creatinine decreased by 50% from baseline or fell to the normal range was significantly higher than that in the control group (p < 0.05). Conclusion: PIRRT + HP therapy could not only improve the general conditions, as measured by APACHE II score, but also reduce the inflammatory cascade of patients with acute pancreatitis. For MSAP and SAP patients complicated with AKI, this therapy may accelerate the recovery of renal function.

© 2022 S. Karger AG, Basel

References Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet. 2015;386(9988):85–96. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11. Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg. 2006;93(6):738–44. Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis. Gastroenterology. 2019;156(7):2008–23. Schetz M. Non-renal indications for continuous renal replacement therapy. Kidney Int Suppl. 1999(72):S88–94. Edrees F, Li T, Vijayan A. Prolonged intermittent renal replacement therapy. Adv Chronic Kidney Dis. 2016;23(3):195–202. Marshall MR, Creamer JM, Foster M, Ma TM, Mann SL, Fiaccadori E, et al. Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries. Nephrol Dial Transplant. 2011;26(7):2169–75. Kitchlu A, Adhikari N, Burns KEA, Friedrich JO, Garg AX, Klein D, et al. Outcomes of sustained low efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study. BMC Nephrol. 2015;16:127. Huang Z, Wang S-R, Su W, Liu J-Y. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial. 2010;14(6):596–602. Tang XY, Ren JA, Gu GS, Chen J, Fan YP, Li JS. Protein loss in critically ill patients during continuous veno-venous hemofiltration. Zhonghua Wai Ke Za Zhi. 2010;48(11):830–3. Gardner TB. Acute pancreatitis. Ann Intern Med. 2021;174(2):ITC17–32. Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: a review. JAMA. 2021;325(4):382–90. Jiang H-L, Xue W-J, Li D-Q, Yin A-P, Xin X, Li C-M, et al. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis. World J Gastroenterol. 2005;11(31):4815–21. Pupelis G, Plaudis H, Grigane A, Zeiza K, Purmalis G. Continuous veno-venous haemofiltration in the treatment of severe acute pancreatitis: 6-year experience. HPB. 2007;9(4):295–301. Hu B, Yang X-R, Xu Y, Sun Y-F, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212–22. Xiang Z-J, Hu T, Wang Y, Wang H, Xu L, Cui N. Neutrophil-lymphocyte ratio (NLR) was associated with prognosis and immunomodulatory in patients with pancreatic ductal adenocarcinoma (PDAC). Biosci Rep. 2020;40(6). Silvester W. Mediator removal with CRRT: complement and cytokines. Am J Kidney Dis. 1997;30(5 Suppl 4):S38–43. De Vriese AS, Colardyn FA, Philippé JJ, Vanholder RC, De Sutter JH, Lameire NH. Cytokine removal during continuous hemofiltration in septic patients. J Am Soc Nephrol. 1999;10(4):846–53. Wang Y, Lu J, Tao Y. Impact of daytime continuous veno-venous haemofiltration on treatment of paediatric tumour lysis syndrome. J Int Med Res. 2018;46(9):3613–20. Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000;356(9223):26–30. Liu L-Y, Zhu Y-J, Li X-L, Liang Y-F, Liang Z-P, Xia Y-H. Blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration for patients with multiple organ dysfunction syndrome. World J Emerg Med. 2012;3(1):44–8. Li Z, Wang G, Zhen G, Zhang Y, Liu J, Liu S. Effects of hemodialysis combined with hemoperfusion on severe acute pancreatitis. Turk J Gastroenterol. 2018;29(2):198–202. Article / Publication Details

First-Page Preview

Received: December 05, 2021
Accepted: May 07, 2022
Published online: July 04, 2022

Number of Print Pages: 11
Number of Figures: 2
Number of Tables: 6

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU