Evaluation of the use of combined extracorporeal detoxification in patients with severe acute pancreatitis: a retrospective cohort study
Issue 3 (2023) , SEPSIS AND SEPTIC SHOCK
Issue 3 (2023)
SEPSIS AND SEPTIC SHOCK

Evaluation of the use of combined extracorporeal detoxification in patients with severe acute pancreatitis: a retrospective cohort study

https://doi.org/10.21320/1818-474X-2023-3-108-121
Published 28.07.2023
S.V. Masolitin
Pirogov City Clinical Hospital No 1, Moscow, Russia; Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-6809-6163
Denis N. Protsenko
Moscow's Multidisciplinary Clincal Center “Kommunarka”, Moscow, Russia; Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-5166-3280
I.N. Tyurin
Moscow's Multidisciplinary Clincal Center “Kommunarka”, Moscow, Russia; Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-5696-1586
T.G. Kim
Pirogov City Clinical Hospital No 1, Moscow, Russia; Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0003-0159-2493
M.A. Magomedov
Pirogov City Clinical Hospital No 1, Moscow, Russia; Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-1972-7336
L.A. Grishina
Pirogov City Clinical Hospital No 1, Moscow, Russia
https://orcid.org/0000-0002-4712-2414
E.B. Gelfand
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0001-5531-1015
O.V. Ignatenko
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia; S.S. Yudin City Clinical Hospital, Moscow, Russia
https://orcid.org/0000-0002-6353-2552
A.O. Bykov
Moscow's Multidisciplinary Clincal Center “Kommunarka”, Moscow, Russia; Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0001-5244-7769
E.Y. Kalinin
Pirogov City Clinical Hospital No 1, Moscow, Russia
https://orcid.org/0000-0002-3403-4925
A.V. Yaralyan
Pirogov City Clinical Hospital No 1, Moscow, Russia
https://orcid.org/0000-0002-4685-7822
#2023-3
PDF_2023-3_108-121 (Русский)

Keywords

pancreatitis
hemoperfusion
hemofiltration
continuous renal replacement therapy
interleukin-6
acute kidney injury

How to Cite

Masolitin S.V., Protsenko D.N., Tyurin I.N., Kim T.G., Magomedov M.A., Grishina L.A., Gelfand E.B., Ignatenko O.V., Bykov A.O., Kalinin E.Y., Yaralyan A.V. Evaluation of the use of combined extracorporeal detoxification in patients with severe acute pancreatitis: a retrospective cohort study. Annals of Critical Care. 2023;(3):108–121. doi:10.21320/1818-474X-2023-3-108-121.
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver AMA GOST

Download Citation

Endnote/Zotero/Mendeley (RIS) BibTeX

Statistic

Abstract Views: 108
PDF_2023-3_108-121 (Русский) Downloads: 68
Statistic from 21.01.2023

Language

English Русский

Announcements

Social Networks

Abstract

INTRODUCTION: Morbidity and mortality of severe acute pancreatitis (SAP) remains high. The most important direction of therapy is the relief of endotoxicosis. The use of extracorporeal detoxification (ECD) is a debatable problem. OBJECTIVE: Improving the results of treatment of patients with SAP, through the use of ECD methods. MATERIALS AND METHODS: The study included 25 patients. Group 1: ECD included 9 patients who used standard therapy with selective hemoperfusion (HP) and continuous veno-venous hemofiltration (CVVHF). Group 2 (control) 16 patients received standard therapy. We performed a comparative analysis of the main clinical and laboratory parameters and treatment outcomes between the groups. RESULTS: The use of ECD allowed to reduce the number of leukocytes from 14.9 to 8.6 × 109/l by 5 days of therapy in group 1, and from 17.6 to 16.1 × 109/l in group 2, respectively. The dynamics of CRP concentration from 1 to 5 days changed from 315.6 to 184.6 mg/ml and 274.2 to 352.9 mg/ml in groups 1 and 2, respectively. The level of PCT concentration on days 1–5 decreased from 4.5 to 2.1 ng/ml and 3.95 to 6.9 ng/ml in groups 1 and 2, respectively. The concentration of IL-6 decreased from 1624.3 to 914.3 pg/ml in group 1, and increased from 1529.8 to 1861.8 pg/ml in group 2, respectively. The dynamics of pH in group 1 was from 7.14 to 7.4 by the 5th day of therapy and 7.13 to 7.22 in group 2, respectively. SOFA by day 5 in group 1 was 4 points and 11 points in group 2, respectively. CONCLUSIONS: The use of HP and CVVHF in complex intensive care is accompanied by a significant regression of markers of endogenous intoxication, resolution of the acid-base state and reduces the severity of organ dysfunction and the risk of adverse outcomes, compared with standard treatment.

https://doi.org/10.21320/1818-474X-2023-3-108-121
PDF_2023-3_108-121 (Русский)

Full-text of the article is available for this locale: Русский.

References

  1. Pandol S.J., Saluja A.K., Imrie C.W., et al. Acute pancreatitis: bench to the bedside [published correction appears in Gastroenterology. 2007; 133(3): 1056]. Gastroenterology. 2007; 132(3): 1127–51. DOI: 10.1053/j.gastro.2007.01.055
  2. Garg P.K., Singh V.P. Organ Failure Due to Systemic Injury in Acute Pancreatitis. Gastroenterology. 2019; 156(7): 2008–23. DOI: 10.1053/j.gastro.2018.12.041
  3. Saluja A., Dudeja V., Dawra R., et al. Early Intra-Acinar Events in Pathogenesis of Pancreatitis. Gastroenterology. 2019; 156(7): 1979–93. DOI: 10.1053/j.gastro.2019.01.268
  4. Jancsó Z., Sahin-Tóth M. Mutation That Promotes Activation of Trypsinogen Increases Severity of Secretagogue-Induced Pancreatitis in Mice. Gastroenterology. 2020; 158(4): 1083–94. DOI: 10.1053/j.gastro.2019.11.020
  5. Boxhoorn L., Voermans R.P., Bouwense S.A., et al. Acute pancreatitis [published correction appears in Lancet. 2021; 398(10312): 1686]. Lancet. 2020; 396(10252): 726–34. DOI: 10.1016/S0140-6736(20)31310-6
  6. Zhan X., Wan J., Zhang G., et al. Elevated intracellular trypsin exacerbates acute pancreatitis and chronic pancreatitis in mice. Am J Physiol Gastrointest Liver Physiol. 2019; 316(6): G816–G825. DOI: 10.1152/ajpgi.00004.2019
  7. Barreto S.G., Habtezion A., Gukovskaya A., et al. Critical thresholds: key to unlocking the door to the prevention and specific treatments for acute pancreatitis. Gut. 2021; 70(1): 194–203. DOI: 10.1136/gutjnl-2020-322163
  8. Baron T.H., DiMaio C.J., Wang A.Y., et al. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology. 2020; 158(1): 67–75.e1. DOI: 10.1053/j.gastro.2019.07.064
  9. Hietaranta A.J., Saluja A.K., Bhagat L., et al. Relationship between NF-kappaB and trypsinogen activation in rat pancreas after supramaximal caerulein stimulation. Biochem Biophys Res Commun. 2001; 280(1): 388–95. DOI: 10.1006/bbrc.2000.4120
  10. Alekhin S.A., Firsova T.I., Nazarenko D.P., et al. Effect of Anti-TNFα Therapy by Infliximab against Pancreatic Tissue Damage in Severe Acute Necrotizing Pancreatitis. Arch Razi Inst. 2021; 76(5): 1237–44. DOI: 10.22092/ari.2021.355845.1726
  11. Goodchild G., Chouhan M., Johnson G.J. Practical guide to the management of acute pancreatitis. Frontline Gastroenterol. 2019; 10(3): 292–9. DOI: 10.1136/flgastro-2018-101102
  12. de-Madaria E., Banks P.A., Moya-Hoyo N., et al. Early factors associated with fluid sequestration and outcomes of patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2014; 12(6): 997–1002. DOI: 10.1016/j.cgh.2013.10.017
  13. Sun S., He L., Bai M., et al. High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis: a controlled pilot study. Ann Saudi Med. 2015; 35(5): 352–8. DOI: 10.5144/0256-4947.2015.352
  14. Gong M., Pan H., Yang X., et al. Prolonged Intermittent Renal Replacement Therapy Combined with Hemoperfusion Can Improve Early Recovery of Moderate and Severe Acute Pancreatitis, Especially in Patients with Acute Kidney Injury. Blood Purif. 2022; 1–11. DOI: 10.1159/000525230
  15. 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(4): 367–71. DOI: 10.1111/j.1744-9987.2005.00299.x
  16. Исмаилов Е.Л., Ералина С.Н., Текесбаев Б.Б., Абдрасулов Р.Б. Методы экстракорпоральной детоксикации в лечении деструктивного панкреатита. Общая реаниматология. 2015; 11(3): 65–74. DOI: 10.15360/1813-9779-2015-3-65-74 [Ismailov E.L., Eralina S.N., Tekesbaev B.B., Abdrasulov R.B. Extracorporeal Detoxification Methods in the Treatment of Destructive Pancreatitis. General Reanimatology. 2015; 11(3): 65–74. DOI: 10.15360/1813-9779-2015-3-65-74 (In Russ)]
  17. Jiang H.L., Xue W.J., Li D.Q., et al. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis. World J Gastroenterol. 2005; 11(31): 4815–21. DOI: 10.3748/wjg.v11.i31.4815
  18. Li Z., Wang G., Zhen G., et al. Effects of hemodialysis combined with hemoperfusion on severe acute pancreatitis. Turk J Gastroenterol. 2018; 29(2): 198–202. DOI: 10.5152/tjg.2018.17415
  19. Banks P.A., Bollen T.L., Dervenis C., et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62(1): 102–11. DOI: 10.1136/gutjnl-2012-302779
  20. Bosslet G.T., Pope T.M., Rubenfeld G.D., et al. An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units. Am J Respir Crit Care Med. 2015; 191(11): 1318–30. DOI: 10.1164/rccm.201505-0924ST
  21. Balthazar E.J. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002; 223(3): 603–13. DOI: 10.1148/radiol.2233010680
  22. Zuccari S., Damiani E., Domizi R., et al. Changes in Cytokines, Haemodynamics and Microcirculation in Patients with Sepsis/Septic Shock Undergoing Continuous Renal Replacement Therapy and Blood Purification with CytoSorb. Blood Purif. 2020; 49(1–2): 107–13. DOI: 10.1159/000502540
  23. Yadav S.C., Zhang B. Effect of Early Continuous Veno-Venous Haemofiltration in Severe Acute Pancreatitis for the Prevention of Local Pancreatic Complications. Gastroenterol Res Pract. 2022; 2022: 7575231. DOI: 10.1155/2022/7575231
  24. Ronco C., Bellomo R., Homel 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. DOI: 10.1016/S0140-6736(00)02430-2
  25. Бажина Е.С., Никулин А.В., Хорошилов С.Е. Экстракорпоральные методы лечения абдоминального сепсиса. Общая реаниматология. 2015; 11(5): 45–66. DOI: 10.15360/1813-9779-2015-5-45-66 [Bazhina E.S., Nikulin A.V., Khoroshilov S.E. Extracorporeal Treatments for Abdominal Sepsis. General Reanimatology. 2015; 11(5): 45–66. DOI: 10.15360/1813-9779-2015-5-45-66 (In Russ)]
  26. Chen L.X., Demirjian S., Udani S.M., et al. Cytokine Clearances in Critically Ill Patients on Continuous Renal Replacement Therapy. Blood Purif. 2018; 46(4): 315–22. DOI: 10.1159/000492025
  27. Abulimiti A., Husaiyin A., Sailai Y. Evaluation of HVHF for the treatment of severe acute pancreatitis accompanying MODS. Medicine (Baltimore). 2018; 97(1): e9417. DOI: 10.1097/MD.0000000000009417
  28. Honoré P.M., Joannes-Boyau O., Gressens B. Blood and plasma treatments: the rationale of high-volume hemofiltration. Contrib Nephrol. 2007; 156: 387–95. DOI: 10.1159/000102129
  29. Ronco C., Ricci Z., Husain-Syed F. From Multiple Organ Support Therapy to Extracorporeal Organ Support in Critically Ill Patients. Blood Purif. 2019; 48(2): 99–105. DOI: 10.1159/000490694
  30. Ranieri V.M., Brodie D., Vincent J.L. Extracorporeal Organ Support: From Technological Tool to Clinical Strategy Supporting Severe Organ Failure. JAMA. 2017; 318(12): 1105–6. DOI: 10.1001/jama.2017.10108
  31. Vincent J.L. Introduction to Extracorporeal Multiple Organ Support. Blood Purif. 2019; 48(2): 97–8. DOI: 10.1159/000492380
  32. Zarbock A., Kellum J.A., Schmidt C., et al. Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: The ELAIN Randomized Clinical Trial. JAMA. 2016; 315(20): 2190–9. DOI: 10.1001/jama.2016.5828
  33. Ricci Z., Romagnoli S., Ronco C., et al. From Continuous Renal Replacement Therapies to Multiple Organ Support Therapy. Contrib Nephrol. 2018; 194: 155–69. DOI: 10.1159/000485634
  34. Fuhrmann V., Perez Ruiz de Garibay A., Faltlhauser A., et al. Registry on extracorporeal multiple organ support with the advanced organ support (ADVOS) system: 2-year interim analysis. Medicine (Baltimore). 2021; 100(7): e24653. DOI: 10.1097/MD.0000000000024653
  35. Karkar A., Ronco C. Prescription of CRRT: a pathway to optimize therapy. Ann Intensive Care. 2020; 10(1): 32. DOI: 10.1186/s13613-020-0648-y
  36. Ronco C., Bellomo R. Acute renal failure and multiple organ dysfunction in the ICU: from renal replacement therapy (RRT) to multiple organ support therapy (MOST). Int J Artif Organs. 2002; 25(8): 733–47. DOI: 10.1177/039139880202500801
  37. Tattersall J.E., Ward R.A.; EUDIAL group. Online haemodiafiltration: definition, dose quantification and safety revisited. Nephrol Dial Transplant. 2013; 28(3): 542–50. DOI: 10.1093/ndt/gfs530
  38. STARRT-AKI Investigators; Canadian Critical Care Trials Group; Australian and New Zealand Intensive Care Society Clinical Trials Group; Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med. 2020; 383(3): 240–51. DOI: 10.1056/NEJMoa2000741
  39. Масолитин С.В., Проценко Д.Н., Тюрин И.Н. и др. Применение селективной гемоперфузии при лечении токсического рабдомиолиза, осложненного острым повреждением почек. Вестник анестезиологии и реаниматологии. 2022; 19(1): 58–66. DOI: 10.21292/2078-5658-2022-19-1-58-66 [Masolitin S.V., Protsenko D.N., Tyurin I.N., et al. The Use of Selective Hemoperfusion in Treatment of Toxic Rhabdomyolysis Complicated by Acute Kidney Injury. Messenger of Anesthesiology and resuscitation. 2022; 19(1): 58–66. DOI: 10.21292/2078-5658-2022-19-1-58-66 (In Russ)]
  40. Rasch S., Sancak S., Erber J., et al. Influence of extracorporeal cytokine adsorption on hemodynamics in severe acute pancreatitis: Results of the matched cohort pancreatitis cytosorbents inflammatory cytokine removal (PACIFIC) study. Artif Organs. 2022; 46(6): 1019–26. DOI: 10.1111/aor.14195
  41. Huber W., Algül H., Lahmer T., et al. Pancreatitis cytosorbents (CytoSorb) inflammatory cytokine removal: A Prospective Study (PACIFIC). Medicine (Baltimore). 2019; 98(4): e13044. DOI: 10.1097/MD.0000000000013044
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Copyright (c) 2023 Annals of Critical Care

Most read articles by the same author(s)

1 2 3 > >>