Ultrafiltration as Treatment in Patients with Acute Pancreatitis Secondary to Hyperlipidemia
Abstracts
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Acute severe pancreatitis has a overall mortality of 30%. Deaths ocurr in two phases: early during the first week wich are due to multisystemic organ failure caused by the release of inflammatory mediators and cytokines; and late deaths from local or systemic infection. With the premise that we could ameliorate the systemic inflammatory response (SIRS) by removing all the circulating cytokines, we decided to ultrafiltrate (UF) patients with pancreatitis secondary to hyperlipidemia. Assuming that large molecules as cholesterol and tryglicerides pass trough the hemophan membrane during the UF, the small molecules of cytokines can be easily removed from the plasma.METHODS: Between 1997 and 2001, we included 6 patients with acute severe pancreatitis secondary to hyperlipidemia to UF, mean age: 36 years. The inclusion criteria were patient with 3 or more Ransons criteria; or CT scan with grade D or E.In all patients we placed a haemodyalisis catheter to achieve a blood flow between 300-350 ml/min to allow a UF volume of 1.2 L per hr. At the same time we used 5%dextrose & 0.9% NaCl solution with calcium plus albumin as plasma substitute.We used Hemophan 1.2 m2 to achieve UF(urea clearence:82-194 ml/min).We measured the effect of the UF in plasma levels of lipids, and in the UF effluent.We survey the clinical course of the pancreatitis, the systemic inflammatory response, the organ failure rate, the hospital stay, and morbidity and mortality in all the patients.RESULTS: The mean Ranson score was 7 for all the patients, with CT scan D in 4 , and E in 2 patients. All had a dramatic response to the UF treatment, with improvement in the clinical course, the hemodynamic parameters, hypoxemia and fluid requirements. There was a significant decrease in the serum lipids post UF , and a important level of triglycerides in the effluent per patient: 20g/L None developed any organic failure or local complications related to the pancreatitis.There was no morbidity or mortality associated with the UF. The hospital stay was 5.5 days/patient.CONCLUSIONS:The UF appears to modify the SIRS in acute pancreatitis secondary to hyperlipidemia. We assume that by removing the cytokines from the plasma the extrapancreatic manifestations of the disease and the organ dysfunction can be supressed.This novel mode of treatment worth to be tested in a large group of patients in a controled design including subgroups of patients with pancreatitis. |
