Acute Crit Care.  2022 Aug;37(3):398-406. 10.4266/acc.2022.00192.

Clinical efficacy of blood purification using a polymethylmethacrylate hemofilter for the treatment of severe acute pancreatitis

• Kinjoh K
• Nagamura R
• Sakuda Y
• Yamauchi S
• Takushi H
• Iraha T
• Idomari K

• KMID: 2535304
• DOI: http://doi.org/10.4266/acc.2022.00192

Abstract

Background
Severe acute pancreatitis (SAP) is a systemic inflammatory disease, and it can often complicate into acute kidney injury (AKI) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS). This study aimed to evaluate the clinical effectiveness of blood purification using a polymethylmethacrylate (PMMA) hemofilter.
Methods
We retrospectively examined 54 patients, who were diagnosed with SAP according to the Japanese criteria from January 2011 to December 2019.
Results
Of a total of 54 SAP patients, 26 patients progressively developed AKI and required continuous hemodialysis with a PMMA membrane hemofilter (PMMA-CHD). Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score were significantly higher in patients requiring PMMA-CHD than in patients not requiring hemodialysis. The lung injury scores were also significantly higher in patients requiring PMMA-CHD. Of the 26 patients, 16 patients developed ALI/ARDS and required mechanical ventilation. A total of seven patients developed severe ALI/ARDS and received additional intermittent hemodiafiltration using a PMMA hemofilter (PMMA-HDF). Although the length of intensive care unit stay was significantly longer in patients with severe ALI/ARDS, blood purification therapy was discontinued in all the patients. The survival rates at the time of discharge were 92.3% and 92.9% in patients with and without PMMA-CHD, respectively. These real mortality ratios were obviously lower than the estimated mortality ratios predicted by APACHE II scores.
Conclusions
These finding suggest that the blood purification using a PMMA hemofilter would be effective for the treatment of AKI and ALI/ARDS in SAP patients.

Keyword

acute kidney injury; acute lung injury; acute respiratory distress syndrome; continuous hemodialysis; polymethylmethacrylate hemofilter; severe acute pancreatitis

Figure

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  Figure 1. (A) Flow diagram and system setup of blood purification using a polymethylmethacrylate (PMMA) hemofilter. (B) The image shows a patient undergoing continuous hemodialysis with a PMMA membrane hemofilter (PMMA-CHD) at the intensive care unit.

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  Figure 2. Flow diagram of patients with acute pancreatitis treated in the intensive care unit (ICU). A total of 54 patients with acute pancreatitis were admitted to our ICU. Among them, 26 patients required continuous hemodialysis with a polymethylmethacrylate membrane hemofilter (PMMA-CHD) during their ICU stay and 16 patients required ventilation for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).

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  Figure 3. Changes of scores of Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, Kidney Disease: Improving Global Outcome (KDIGO) stage, and lung injury score during intensive care unit (ICU) care. Blue boxes: non-hemodialysis group; red boxes: continuous hemodialysis with a polymethylmethacrylate membrane hemofilter (PMMA-CHD) group. Box, 25th–75th percentiles; Error bar, 10th and 90th percentiles; Bold horizontal line, median; closed square, mean value; Open circle, outlier. aP<0.05 as compared with values between the PMMA-CHD and non-hemodialysis groups; bP<0.05 as compared with values between values at the start and end of ICU care in each group.

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