[Blood purification methods for treatment of organ failure in patients with severe pancreatitis].
BACKGROUND
Recent years have shown a considerable progress in the management of severe pancreatitis (SP); however, the role of extracorporeal blood purification in the treatment of progressive multiple organ dysfunction syndrome (MODS) is not well assessed.


OBJECTIVE
The retrospective assessment of the MODS treatment results after application of extracorporeal blood purification methods in SP patients.


METHODS
50 consecutive patients with acute pancreatitis were included in the study. Atlanta classification system was applied for stratification of patients with SP. MODS was defined according to the recommendations of the Consensus Conference of American College of Chest Physicians/Society of Critical Care Medicine in 1991, and MODS score was calculated. Involvement of the organ systems, ICU, hospital stays and main outcomes were analyzed.


RESULTS
Totally, 45 patients met SP criteria. Necrotizing pancreatitis was found in 35 patients. In 19 cases the clinical course was complicated with peritonitis, in two with jaundice. Infection was present in four patients. MODS were observed in 34 patients, with average of 3.3-organ involvement. In total, 21 patients underwent surgery. Hemodialysis was necessary in 5 of the 21 patients with necrotizing pancreatitis. Hemofiltration was applied in 5, hemadsorption in 28 and plasmapheresis in 23 patients. The overall mortality in association with hemodialysis and hemofiltration reached 20 % in necrotizing pancreatitis patients. Hemadsorption was associated with 3.8 % mortality, and plasmapheresis with 25 % mortality rate in all SP patients.


CONCLUSIONS
Combined derangement of the renal and hepatic function is highly associated with unfavorable outcome in patients with severe pancreatitis. Timely application of the extracorporeal blood purification methods may revert progression of MODS and can be successfully combined with surgery if it is needed in this category of patients.
Pupelis
G
G
Medical Academy of Latvia, Department of Surgery, Clinical Hospital "Gailezers", Riga, Latvia.
Austrums
E
E
Snippe
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006382:Hemadsorption; D006440:Hemofiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000628:therapy*; D010956:Plasmapheresis; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D016060:Sorption Detoxification; D013997:Time Factors