Removal of cytokines from blood by hemosorption in acute destructive pancreatitis

Abstract

Relevance. The development of acute destructive pancreatitis is accompanied by explosive
activation of mediators of systemic inflammation. Their removal from the blood can
reduce the systemic damaging effects.
Goal. To evaluate the effectiveness of extracorporeal
removal of substances from the blood that contribute to the development of systemic
inflammation and multiple organ failure in patients with acute destructive pancreatitis.
Materials and methods. A randomized clinical trial was conducted in
a cohort of 40 patients with acute destructive pancreatitis admitted to the hospital
with a disease duration of no more than 3 days. All of them had signs
of severe destructive pancreatitis, determined according to the international scale (Atlanta, 1992) and
the scale of the Russian Society of Surgeons. Due to the fact that these scales are focused on
the final diagnosis of the severity of acute pancreatitis,
the RAPID scale of the St. Petersburg
I.I. Dzhanelidze Research Institute of Emergency Medicine, recommended for use by Russian National Clinical Guidelines, was used to assess it on the first day
of hospitalization. The experimental 1 group included 9 randomly selected
patients (43±3 years old) who underwent
one extracorporeal selective cytokine hemosorption in addition to the ongoing treatment.
180 minutes using the Efferon-CT speakers. The rest – 31 patients (44±2
years) – made up the comparison group 2.
Results. In group 1 patients
, 40-50% of cytokines (IL-6, IL-8, and IL-10), as well as 50% of activated
CD14+monocytes, 25% of antigen-presenting HLA-DR+mononuclears, and 15% were removed from the blood during hemosorption.%
C-reactive protein. On day 3, the IL-6 level in group 1 decreased 3.6-fold (from 427±178
up to 118±59 pg/ml), and in group 2 – 1.6 times (from 404±122 to 251±38 pg/ml), p=0.067. For ana
According to the final mortality rate, all patients were divided by severity into 2 categories: more
severe and less severe. In both groups, the mortality rate in more severe patients (9 points or higher
on the EXPRESS scale) was practically the same and was
the highest (group 1 - 100%, group 2 – 86%, p=0.916), while in less severe
patients (5-8 points on the EXPRESS scale) The difference in mortality rates between
the groups was significant and close to statistically significant (group 1-0%, group
2 – 38%, p=0.100).
Conclusion. The use of selective cytokine hemosorption can improve
the survival of patients with severe acute destructive pancreatitis when
performed early in patients with a severity of 5 to 8 points when evaluated on an EXPRESS scale.
St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze.