Early Continuous Veno-Venous Hemofiltration Is Effective in Decreasing Intra-Abdominal Pressure and Serum Interleukin-8 Level in Severe Acute Pancreatitis Patients with Abdominal Compartment Syndrome

Xu, Jiacheng; Ying, Chunmei; Tian, Xiangping

doi:10.1159/000480223

Cited by 17 publications

(20 citation statements)

References 19 publications

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“…This may be because abdominal pain and increased respiratory rate in patients with SAP are associated with elevated intra-abdominal pressure and acute lung injury during the early stages of the disease. Previous studies have shown that elevated intra-abdominal pressure and acute lung injuries are related to inflammation, which can be suppressed by ulinastatin (18,19). To an extent, increasing the ulinastatin dose can reduce intra-abdominal pressure and fluid exudation in the lungs, thus resulting in the different dose responses to ulinastatin in terms of reducing abdominal pain relief time and the time taken to recover a normal respiratory rate, but not the time taken to recover a normal heart rate.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of different doses of ulinastatin in the treatment of severe acute pancreatitis

He¹,

Zhang²

2020

Ann Palliat Med

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Background: Severe acute pancreatitis (SAP) is a severe form of inflammatory disease with a high mortality rate. Ulinastatin, a urinary trypsin inhibitor, has anti-inflammatory properties and may be beneficial to critically ill patients with SAP. Nevertheless, there is currently insufficient evidence to conclude whether there is a dose-effect relationship between ulinastatin and SAP treatment outcomes. The present study examined the efficacy of ulinastatin at different doses in the treatment of SAP.Methods: A retrospective study was conducted examining the clinical outcomes of 130 SAP patients.Patients were categorized into a control group and three groups receiving different daily doses of ulinastatin (200,000; 400,000; and 600,000 IU). The study compared the 1-week mortality rate; the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score; abdominal pain relief time; time to recover a normal heart and respiratory rate; blood amylase, glucose, C-reactive protein, and procalcitonin levels; and white blood cell (WBC) count among the different groups.Results: The 400,000 and 600,000 IU groups had significantly lower mortality rates and WBC count compared to the 200,000 IU group (P<0.05). Furthermore, the 400,000 IU group had a significantly shorter abdominal pain relief time compared to the 200,000 IU group (P<0.05). Compared to the 200,000 IU group, the 600,000 IU group had significantly shorter time to recover a normal respiratory rate and a lower APACHE-II score (P<0.05).Conclusions: Ulinastatin can improve the clinical outcomes of patients with SAP but efficacy varies with the dosage.

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Section: Discussionmentioning

confidence: 99%

The efficacy of different doses of ulinastatin in the treatment of severe acute pancreatitis

He¹,

Zhang²

2020

Ann Palliat Med

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“…The pooled results on Bun, Cr, ALT, CRP, and APACHE II indicated that continuous hemofiltration could effectively alleviate SAP as early as 72 hours after the onset of treatment. Moreover, in order to secure the efficacy and credibility of the pooled results, a study without baseline data was excluded [ 31 , 35 ]. Besides, retrospective studies in which only SAP patients with complications could receive continuous hemofiltration treatment and constituted the hemofiltration group were not included in the present study, because this study design induced great bias.…”

Section: Discussionmentioning

confidence: 99%

Continuous Hemofiltration Reduces Mortality in Severe Acute Pancreatitis: A Meta-Analysis

Guo

Cao

et al. 2020

Emergency Medicine International

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Background. Severe acute pancreatitis (SAP) is a deadly condition, with a mortality rate ranging from 15% to 30%. Recently, blood purification therapy has been adopted in administrating SAP patients. The present study aimed at evaluating the effect of continuous hemofiltration therapy for SAP. Methods. A systematic search of Cochrane Library, PubMed, and Embase was carried out until October 1st, 2019. Prospective studies comparing outcomes for SAP patients between continuous hemofiltration and standard therapy were enrolled. Results. Continuous hemofiltration therapy was associated with lower level of PACHE II score (MD = −1.49; 95% CI: −2.69 to −0.29, P=0.02), CRP (MD = −1.56 mg/L; 95% CI: −2.64 to −0.47, P=0.005), Cr (MD = −3.57 umol/L; 95% CI: −5.50 to −1.65, P=0.003), and Bun (MD = −3.63 mmol/L; 95% CI: −6.07 to −1.20, P=0.003) at 72 h after onset of treatment. Continuous hemofiltration therapy was associated with shorter length of abdominal pain relief time (MD = −1.82 hours; 95% CI: −2.93 to −0.71, P=0.001), lower surgery rate (OR = 0.15; 95% CI: 0.03 to 0.78, P=0.02), and mortality rate (OR = 0.54; 95% CI: 0.37 to 0.77, P=0.0007). Conclusions. continuous hemofiltration therapy could effectively alleviate SAP as early as 72 hours after onset of treatment, lowering the level of Bun, Cr, CRP, and APACHE II scores. Continuous hemofiltration therapy could confer SAP patients with lower mortality rates.

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“…Während in Beobachtungsstudien (einschließlich Follow-up of ELAIN Trial) ein Überlebensvorteil in der Gruppe mit früher Einleitung einer RRT gesehen wurde, konnte dies sowohl in den randomisierenden Studien (AKIKI-Trial, ELAIN-Trial, IDEAL-ICU-Trial) als auch in deren sekundären Nachuntersuchungen nicht bestätigt werden (▶ Tab. 4) [198][199][200][201][202][203] Weiterer Vorteil der kontinuierlichen Dialyse ist eine Entfernung von Zytokinen [205]. Eine niedrigintensive kontinuierliche venovenöse Hämofiltration (CVVH) bietet jedochaufgrund der im Rahmen einer AP riesigen Menge an freigesetzten zirkulierenden Entzündungsmediatorenein nicht ausreichendes Eliminationspotenzial, sodass eine hochvolumige CVVHinsbesondere bei frühem Beginnwirksamer sein könnte [206].…”

Section: Zeitpunkt Modalität Und Antikoagulation Für Eine Nierenersaunclassified

Pankreatitisbedingte akute Nierenschädigung (AP-AKI): Definition, Pathophysiologie, Diagnostik und Therapie

et al. 2020

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ZusammenfassungDie akute Pankreatitis (AP) stellt die häufigste gastrointestinale Ursache für Krankenhausaufnahmen dar. Die Mortalität liegt bei 5 %, kann jedoch in Abhängigkeit vom Schweregrad auf bis zu 40 % ansteigen. Insbesondere schwere Verlaufsformen sind mit einem Multiorganversagen vergesellschaftet und haben eine schlechte Prognose. In diesem Zusammenhang kann es bei bis zu 10 % der Patienten zum akuten Nierenversagen (Acute kidney injury, AKI) kommen, das sich meistens spät nach dem Versagen anderer Organe entwickelt, aber auch initial oder isoliert auftreten kann. Darüber hinaus bestimmt das AKI als Komplikation der schweren Pankreatitis maßgeblich die Prognose, da die Mortalität, vor allem bei dialysepflichtigem AKI, auf bis zu 75 % dramatisch ansteigen kann.Im Vergleich zu anderen intensivmedizinisch assoziierten AKIs (z. B. Volumenmangel, kardiales Pumpversagen, Sepsis oder Intoxikationen) weist das mit einer AP assoziierte AKI (AP-AKI) viele Gemeinsamkeiten, aber auch deutliche Unterschiede auf. Die zwei existierenden Formen des AP-AKI (initiale prärenale Schädigung aufgrund eines Volumenmangels, intrarenale Schädigung in der Spätphase) können aufeinander folgend, aber auch unabhängig voneinander auftreten. Obwohl die Pathophysiologie gänzlich unverstanden ist, scheint eine systemische und lokale entzündliche Reaktion eine wichtige Rolle zu spielen. Die frühe Diagnose und die rechtzeitige Einleitung einer effektiven supportiven und ätiopathogenetisch gerichteten Therapie kann die Prognose deutlich verbessern. Ungeachtet dessen finden sich derzeit nur wenige Studien, die sich explizit mit AKI und Pankreatitis befassen.In der vorliegenden Übersicht konzentrieren wir uns – unter Verwendung der aktuellsten Literatur – auf die zugrunde liegenden pathophysiologischen Mechanismen des AP-AKI, untersuchen in dieser Hinsicht den diagnostischen und prognostischen Stellenwert alter und neuer Serum- und Urinmarker und diskutieren die für die AP-AKI empfohlenen Behandlungsansätze inklusive möglicher Nierenersatzverfahren.

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Early Continuous Veno-Venous Hemofiltration Is Effective in Decreasing Intra-Abdominal Pressure and Serum Interleukin-8 Level in Severe Acute Pancreatitis Patients with Abdominal Compartment Syndrome

Cited by 17 publications

References 19 publications

The efficacy of different doses of ulinastatin in the treatment of severe acute pancreatitis

The efficacy of different doses of ulinastatin in the treatment of severe acute pancreatitis

Continuous Hemofiltration Reduces Mortality in Severe Acute Pancreatitis: A Meta-Analysis

Pankreatitisbedingte akute Nierenschädigung (AP-AKI): Definition, Pathophysiologie, Diagnostik und Therapie

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