Clinical efficacy of blood purification using a polymethylmethacrylate hemofilter for the treatment of severe acute pancreatitis

• Published in: Acute and critical care Vol. 37; no. 3; pp. 398 - 406
• Main Authors: Kinjoh, Kiyohiko, Nagamura, Ryoji, Sakuda, Yutaka, Yamauchi, Shoki, Takushi, Hideta, Iraha, Tadashi, Idomari, Koji
• Format: Journal Article
• Language: English
• Published: Korean Society of Critical Care Medicine 01.08.2022; 대한중환자의학회
• Subjects: acute kidney injury; acute lung injury; acute respiratory distress syndrome; continuous renal replacement therapy; Original; pancreatitis; polymethylmethacrylate hemofilter; 마취과학
• ISSN: 2586-6052; 2586-6060
• DOI: 10.4266/acc.2022.00192

Background: Severe acute pancreatitis (SAP) is a systemic inflammatory disease, and it can often complicate into acute kidney injury (AKI) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS). This study aimed to evaluate the clinical effectiveness of blood purification using a polymethylmethacrylate (PMMA) hemofilter.Methods: We retrospectively examined 54 patients, who were diagnosed with SAP according to the Japanese criteria from January 2011 to December 2019.Results: Of a total of 54 SAP patients, 26 patients progressively developed AKI and required continuous hemodialysis with a PMMA membrane hemofilter (PMMA-CHD). Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score were significantly higher in patients requiring PMMA-CHD than in patients not requiring hemodialysis. The lung injury scores were also significantly higher in patients requiring PMMA-CHD. Of the 26 patients, 16 patients developed ALI/ARDS and required mechanical ventilation. A total of seven patients developed severe ALI/ARDS and received additional intermittent hemodiafiltration using a PMMA hemofilter (PMMA-HDF). Although the length of intensive care unit stay was significantly longer in patients with severe ALI/ARDS, blood purification therapy was discontinued in all the patients. The survival rates at the time of discharge were 92.3% and 92.9% in patients with and without PMMA-CHD, respectively. These real mortality ratios were obviously lower than the estimated mortality ratios predicted by APACHE II scores.Conclusions: These finding suggest that the blood purification using a PMMA hemofilter would be effective for the treatment of AKI and ALI/ARDS in SAP patients.