New Therapy For Early Severe Acute Pancreatitis

About 50% of deaths in patients with SAP happen during the early stages; these patients suffer a severe initial attack and develop an exaggerated systemic inflammatory response syndrome (SIRS), with the development of multiple organ dysfunction syndrome (MODS) and death. Therefore, the role for therapy targeting the inflammatory response in the patient with SAP has been recently looked into.

The onset and deterioration of SAP is likely due to over-released pro-inflammatory cytokines, which are considered the center of the disease. Inhibition of the cytokine cascade would potentially alleviate the pancreatic and systematic inflammation and improve the outcome of SAP.

Thus, veno-venous hemofiltration has been used in early management of SAP since 1991, as it can eliminate cytokines efficiently. There were different kinds of modalities of hemofiltration for SAP, but the effectiveness of them remained controversial. This expensive therapy should be used discreetly and carefully in China, a developing country, considering its cost-effectiveness.

Based on our previous meta-analysis, early veno-venous hemofiltration could decrease the overall mortality rate significantly. In different modalities, continuous or long-term veno-venous hemofiltration (CVVH/LVVH) and short-term veno-venous hemofiltration plus peritoneal dialysis (SVVH+PD) were without statistical significance in decreasing the mortality of SAP, while short-term only modality (SVVH only) was superior in this respect.

Present cost-effectiveness analysis based on Chinese literature found that SVVH was the best cost-effective modality in decreasing mortality, preventing complications in China. The timing interval of veno-venous hemofiltration should be regarded as a critical factor for the outcome of patients with SIRS or sepsis.

Early veno-venous hemofiltration is considered as an alternative therapy for SAP, but it is expensive for the common populace in China. According to current evidence, hemofiltration can control SIRS and even MODS in the early stage to a certain extent, with SVVH being a cost-effective modality for Chinese. We can predict that the early short-term high-volume veno-venous hemofiltration would play a more important role in management of SAP with definite SIRS, sepsis or organ failure. However, further in depth studies are still needed.