High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis: a controlled pilot study

Shiren Sun, Lijie He, Ming Bai, Hongbao Liu, Yangping Li, Li Li, Yan Yu, Meilan Shou, Rui Jing, Liyuan Zhao, Chen Huang, Hanmin Wang, Shiren Sun, Lijie He, Ming Bai, Hongbao Liu, Yangping Li, Li Li, Yan Yu, Meilan Shou, Rui Jing, Liyuan Zhao, Chen Huang, Hanmin Wang

Abstract

Background and objectives: The evidence for high-volume hemofiltration plus hemoperfusion (HVHF&HP) for hyperlipidemic severe acute pancreatitis (HL-SAP) is anecdotal. The purpose of our study was to evaluate the efficacy of HVHF&HP for HL-SAP in a prospective controlled study.

Design and setting: Prospective controlled pilot study between May 2010 and May 2013 in a hospital intensive care unit.

Patients and methods: HL-SAP patients chose conventional treatment alone (the control group) or conventional treatment combined with the experimental protocol (the HVHF&HP group) and were prospectively followed in our hospital. APACHE II score, SOFA score, ICU and hospital stay duration, and serum biomarkers were considered endpoints.

Results: Ten HL-SAP patients accepted conventional treatment alone (the control group) and 10 patients underwent HVHF&HP combined with conventional treatment (the HVHF&HP group). The APACHE II score, SOFA score, systolic blood pressure, diastolic blood pressure, heart rate, serum amylase, and serum creatinine were significantly reduced after the HVHF&HP treatment. The changes in these variables were significantly different between the HVHF&HP and control group at 48 hours after the initiation of treatment. Patients in the HVHF&HP group had a significantly shorter ICU stay (P=.015). The reduction in serum triglyceride and cholesterol in the HVHF&HP group after 2, 6, 12, 24, and 48 hours was greater than the control group. All of the tested serum cytokines were significantly decreased after HVHF&HP treatment (P < .05). However, in patients who underwent conventional treatment alone, there was no significant change in the serum cytokines.

Conclusion: This study suggests that the addition of HVHF&HP to conventional treatment for HL-SAP patients may be superior to conventional treatment alone for the improvement of serum biomarkers and clinical outcomes.

Conflict of interest statement

Conflict of interest

No conflict of interest is declared.

Figures

Figure 1
Figure 1
Serum CHO and TG levels at 0-, 2-, 6-, 12-, 24-, 48-hour after the initiation of treatment. *Variables differed significantly from their baseline value; ‡Variables differed significantly from the control group.
Figure 2
Figure 2
Serum IL-1, IL-2, IL-6, IL-8, IL-10, and TNF-a level at 0-, 2-, 6-, 12-, 24-, 48-hour after the initiation of treatment. *Variables differed significantly from their baseline value; ‡Variables differed significantly from the control group.
Figure 3
Figure 3
IL-1, IL-2, IL-6, IL-8, IL-10, and TNF-a levels of the effluent displacement liquid increased after 6, 12, 24, and 48 hours of HVHF&HP treatment.

References

    1. Iskandar SB, Olive KE. Plasmapheresis as an adjuvant therapy for hypertriglyceridemia-induced pancreatitis. Am J Med Sci. 2004;328:290–4.
    1. Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol. 2003;36:54–62.
    1. Kyriakidis AV, Raitsiou B, Sakagianni A, et al. Management of acute severe hyperlipidemic pancreatitis. Digestion. 2006;73:259–64.
    1. Hen K, Bogdanski P, Pupek-Musialik D. [Successful treatment of severe hypertriglyceridemia with plasmapheresis--case report]. Pol Merkur Lekarski. 2009;26:62–4.
    1. Saravanan P, Blumenthal S, Anderson C, et al. Plasma exchange for dramatic gestational hyperlipidemic pancreatitis. J Clin Gastroenterol. 1996;22:295–8.
    1. Kadikoylu G, Yavasoglu I, Bolaman Z. Plasma exchange in severe hypertriglyceridemia a clinical study. Transfus Apher Sci. 2006;34:253–7.
    1. Tang Y, Zhang L, Fu P, et al. Hemoperfusion plus continuous veno-venous hemofiltration in a pregnant woman with severe acute pancreatitis: a case report. Int Urol Nephrol. 2012;44:987–90.
    1. Bradley EL., 3rd A clinically based classification system for acute pancreatitis. Arch Surg; Summary of the International Symposium on Acute Pancreatitis; Atlanta, Ga. September 11 through 13, 1992; 1993. pp. 586–90.
    1. Toouli J, Brooke-Smith M, Bassi C, et al. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol. 2002;17(Suppl):S15–39.
    1. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/ SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644–55.
    1. Tsuang W, Navaneethan U, Ruiz L, et al. Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol. 2009;104:984–91.
    1. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362:1491–502.
    1. Fortson MR, Freedman SN, Webster PD., 3rd Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995;90:2134–9.
    1. Mao EQ, Tang YQ, Zhang SD. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis. World J Gastroenterol. 2003;9:2622–6.
    1. Chang MC, Su CH, Sun MS, et al. Etiology of acute pancreatitis--a multi-center study in Taiwan. Hepatogastroenterology. 2003;50:1655–7.
    1. Murphy MJ, Sheng X, MacDonald TM, et al. Hypertriglyceridemia and acute pancreatitis. JAMA Intern Med. 2013;173:162–4.
    1. Bush ZM, Kosmiski LA. Acute pancreatitis in HIV-infected patients: are etiologies changing since the introduction of protease inhibitor therapy? Pancreas. 2003;27:e1–5.
    1. Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Am J Gastroenterol. 2000;95:2795–800.
    1. Al-Humoud H, Alhumoud E, Al-Hilali N. Therapeutic plasma exchange for acute hyperlipidemic pancreatitis: a case series. Ther Apher Dial. 2008;12:202–4.
    1. Dominguez-Munoz JE, Junemann F, Malfertheiner P. Hyperlipidemia in acute pancreatitis. Cause or epiphenomenon? Int J Pancreatol. 1995;18:101–6.
    1. Tasaki H, Yamashita K, Saito Y, et al. Lowdensity lipoprotein apheresis therapy with a direct hemoperfusion column: a Japanese multicenter clinical trial. Ther Apher Dial. 2006;10:32–41.
    1. Bosch T, Keller C. Clinical effects of direct adsorption of lipoprotein apheresis: beyond cholesterol reduction. Ther Apher Dial. 2003;7:341–4.
    1. Rinderknecht H, Adham NF, Renner IG, et al. A possible zymogen self-destruct mechanism preventing pancreatic autodigestion. Int J Pancreatol. 1988;3:33–44.
    1. Kobe Y, Oda S, Matsuda K, et al. Direct hemoperfusion with a cytokine-adsorbing device for the treatment of persistent or severe hypercytokinemia: a pilot study. Blood Purif. 2007;25:446–53.
    1. Saotome T, Endo Y, Sasaki T, et al. A case of severe acute pancreatitis treated with CTR-001 direct hemoperfusion for cytokine apheresis. Ther Apher Dial. 2005;9:367–71.
    1. Ronco C, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis. Artif Organs. 2003;27:792–801.
    1. Mao HJ, Yu S, Yu XB, et al. Effects of coupled plasma filtration adsorption on immune function of patients with multiple organ dysfunction syndrome. Int J Artif Organs. 2009;32:31–8.

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