Continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter for severe acute pancreatitis

It has been reported that hypercytokinemia plays a pivotal role in the pathophysiology of severe acute pancreatitis (SAP). In our previous reports, continuous hemodiafiltration (CHDF) using a polymethyl methacrylate (PMMA) membrane hemofilter (PMMA-CHDF) was found to be capable of efficiently removing various cytokines from circulating blood. The present study was undertaken to evaluate the efficacy of PMMA-CHDF aimed at cytokine removal in the treatment of SAP. Patients with blood IL-6 level > or =400 pg/ml were considered indicated for initiation of PMMA-CHDF based on our previous data. Among the patients enrolled in the present study, there were significant differences in APACHE II sore, JMHLW (Japanese Ministry of Health, Labour, and Welfare) severity score, Ranson score, blood lactate level on ICU admission, and length of ICU stay between patients with blood IL-6 levels > or =400 pg/ml and patients with levels < 400 pg/ml. Using this PMMA-CHDF initiation criterion, PMMA-CHDF was performed on 82 SAP patients. Mean blood IL-6 level, which was 998 pg/ml on admission to the ICU, was significantly lower (335 pg/ml) after 3 days treatment of PMMA-CHDF (p < 0.01). In addition, heart rate, blood lactate level, and intra-abdominal pressure also decreased significantly (p < 0.01). At the time of weaning from PMMA-CHDF, blood IL-6 level had decreased to 99 pg/ml. The mortality rate among patients who received PMMA-CHDF was 6.1%, and significantly lower than that of patients before the introduction of PMMA-CHDF under non-renal indication (25.0%). These findings suggest that PMMA-CHDF is effective for treatment of SAP and that it can be expected to contribute to improving the outcome of SAP patients.