Blood purification methods for treatment of organ failure in patients withsevere pancreatitis

Background: Recent years have shown a considerable progress in the manageme nt of severe pancreatitis (SP); however, the role of extracorporeal blood p urification in the treatment of progressive multiple organ dysfunction synd rome (MODS) is not well assessed. The aim of this study: The retrospective assessment of the MODS treatment r esults after application of extracorporeal blood purification methods in SP patients. Methods: 50 consecutive patients with acute pancreatitis were included in t he study. Atlanta classification system was applied for stratification of p atients with SP. MODS was defined according to the recommendations of the C onsensus Conference of American College of Chest Physicians/Society of Crit ical Care Medicine in 1991, and MODS score was calculated. Involvement of t he organ systems, ICU, hospital stays and main outcomes were analyzed. Results: Totally, 45 patients met SP criteria. Necrotizing pancreatitis was found in 35 patients. In 19 cases the clinical course was complicated with peritonitis, in two with jaundice. Infection was present in four patients. MODS were observed in 34 patients, with average of 3.3-organ involvement. In total, 21 patients underwent surgery. Hemodialysis was necessary in 5 of the 21 patients with necrotizing pancreatitis. Hemofiltration was applied in 5, hemadsorption in 28 and plasmapheresis in 23 patients. The overall mo rtality in association with hemodialysis and hemofiltration reached 20% in necrotizing pancreatitis patients. Hemadsorption was associated with 3.8% m ortality, and plasmapheresis with 25% mortality rate in all SP patients. Conclusion: Combined derangement of the renal and hepatic function is highl y associated with unfavorable outcome in patients with severe pancreatitis. Timely application of the extra-corporeal blood purification methods may r evert progression of MODS and can be successfully combined with surgery if it is needed in this category of patients.