title: Sequential blood purification therapy for critical patients with hyperlipidemic severe acute pancreatitis.
abstract: OBJECTIVE
  To evaluate the efficacy of sequential blood purification therapy in the treatment of critical patients with hyperlipidemic severe acute pancreatitis.
  
  
  METHODS
  Thirty-one intensive care unit (ICU) patients with hyperlipidemic severe acute pancreatitis treated at the Second Affiliated Hospital of Harbin Medical University were divided into either a study group (n = 15; July 1, 2012 to June 30, 2014) or a control group (n = 16; July 1, 2010 to June 30, 2012) based on the implementation of sequential blood purification therapy. The control group received continuous venous-venous hemofiltration (CVVH) on the basis of conventional treatments, and the therapeutic dose of CVVH was 30 mL/kg per hour. The study group received sequential plasma exchange and CVVH on the basis of conventional treatments. The anticoagulation regimen of CVVH is the regional citrate anticoagulation. Mortality rate on day 28, rates of systemic and local complications, duration of ICU, and time to target serum lipid level, as well as physiologic and laboratory indices were compared between the two groups.
  
  
  RESULTS
  The mortality rate on day 28 was significantly lower in the study group than in the control group (13.33% vs 37.50%; P < 0.05). The duration of ICU stay was significantly shorter in the study group than in the control group (7.4 ± 1.35 d vs 9.19 ± 2.99 d, P < 0.05). The time to target serum lipid level was significantly shorter in the study group than in the control group (3.47 ± 0.52 d vs 7.90 ± 1.14 d, P < 0.01). There were no significant differences in the rates of systemic complications and local complications between the two groups (60% vs 50% and 80% vs 81%, respectively). In the comparisons of physiologic and laboratory indices, serum albumin and C-reactive protein were significantly better in the study group than in the control group after treatment (37.8 ± 4.6 g/L vs 38.9 ± 5.7 g/L, and 20.5 ± 6.4 mg/L vs 28.5 ± 7.1 mg/L, respectively, both P < 0.05). With the exception of plateletcrit, no other indices showed significant differences between the two groups.
  
  
  CONCLUSIONS
  Sequential blood purification therapy is effective in the treatment of ICU patients with hyperlipidemic severe acute pancreatitis and can improve patient prognosis.
authors.affiliation: Hong-Liang Wang, Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China.
authors.forename: Hong-Liang
authors.initials: HL
authors.lastname: Wang
authors.affiliation: Hong-Liang Wang, Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China.
authors.forename: Kai-Jiang
authors.initials: KJ
authors.lastname: Yu
mesh_terms: D000208:Acute Disease; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002681:China; D019343:Citric Acid / Q000627:therapeutic use; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010951:Plasma Exchange / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D008055:Lipids; D019343:Citric Acid
keywords: Continuous venous-venous hemofiltration; Hyperlipidemic severe acute pancreatitis; Plasma exchange; Sequential blood purification