Effect of Laparoscopic Peritoneal Lavage and Drainage and Continuous Venovenous Diahemofiltration on Severe Acute Pancreatitis

Wang, Guiliang; Liu, Hai; Xu, Li; Wen, Ping; Wen, Jianbo; Zhou, Shu-Feng; Xiao, Xianzhong

doi:10.1089/lap.2016.0637

Cited by 9 publications

(20 citation statements)

References 17 publications

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“…e pooled results showed that continuous hemofiltration therapy could significantly decrease the APACHE II score of SAP patients at 72 h after treatment compared with standard treatment (MD � −1.80; 95% CI: −3.15 to −0.44, P � 0.009; I 2 � 96%, P < 0.00001 for heterogeneity) ( Table 2) [18][19][20][21][22]. When the severity of SAP got worse despite the routine or continuous hemofiltration therapy, these patients would need surgical intervention.…”

Section: E Pooled Results Of Items Regarding Primary Endpoints and Homentioning

confidence: 99%

“…General information including the characteristics and demographics of all included studies is shown in Table 1 . The quality of most included RCTs except Wang et al's [ 21 ] study was relatively low. However, all the 2 prospective studies scored eight stars, indicating high quality ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…For APACHE II score at 24 h after treatment, heterogeneity remained high when carrying out the sensitivity analysis. After excluding Wang et al's study [21], APACHE II score at 24 h became significantly lower for patients receiving continuous hemofiltration therapy (MD � −3.67; 95% CI: −6.40 to −0.94, P � 0.008; I 2 � 65%, P � 0.09 for heterogeneity). For APACHE II score at 72 h after treatment, sensitivity analysis was carried out with no significant change in results.…”

Section: Sensitivity Analysismentioning

confidence: 88%

“…Finally, 9 studies met the inclusion criteria for qualitative synthesis (Table 1) ( Figure 1) [15][16][17][18][19][20][21][22][23]. In quantitative synthesis, 8 studies were included (Table 1) ( Figure 1) [15][16][17][18][19][20][21][22]. A total of 470 patients were eligible in quantitative synthesis, with 242 patients receiving continuous hemofiltration therapy and 228 controls.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…However, no publication bias was found by Begg's and Egger's tests (Begg's tests, P � 0.296; Egger's tests, P � 0.158). e funnel plot on APACHE II scores at 72 h after treatment showed two studies analyzed were in the significant areas, which indicated the existence of publication bias (Figure 2(c)) [18][19][20][21][22]. However, there was also no publication bias found by both Begg's and Egger's tests regarding APACHE II score at 72 h after treatment (Begg's tests, P � 0.806; Egger's tests, P � 0.542).…”

Section: Publication Biasmentioning

confidence: 99%

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Continuous Hemofiltration Reduces Mortality in Severe Acute Pancreatitis: A Meta-Analysis

Guo

Cao

et al. 2020

Emergency Medicine International

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Background. Severe acute pancreatitis (SAP) is a deadly condition, with a mortality rate ranging from 15% to 30%. Recently, blood purification therapy has been adopted in administrating SAP patients. The present study aimed at evaluating the effect of continuous hemofiltration therapy for SAP. Methods. A systematic search of Cochrane Library, PubMed, and Embase was carried out until October 1st, 2019. Prospective studies comparing outcomes for SAP patients between continuous hemofiltration and standard therapy were enrolled. Results. Continuous hemofiltration therapy was associated with lower level of PACHE II score (MD = −1.49; 95% CI: −2.69 to −0.29, P=0.02), CRP (MD = −1.56 mg/L; 95% CI: −2.64 to −0.47, P=0.005), Cr (MD = −3.57 umol/L; 95% CI: −5.50 to −1.65, P=0.003), and Bun (MD = −3.63 mmol/L; 95% CI: −6.07 to −1.20, P=0.003) at 72 h after onset of treatment. Continuous hemofiltration therapy was associated with shorter length of abdominal pain relief time (MD = −1.82 hours; 95% CI: −2.93 to −0.71, P=0.001), lower surgery rate (OR = 0.15; 95% CI: 0.03 to 0.78, P=0.02), and mortality rate (OR = 0.54; 95% CI: 0.37 to 0.77, P=0.0007). Conclusions. continuous hemofiltration therapy could effectively alleviate SAP as early as 72 hours after onset of treatment, lowering the level of Bun, Cr, CRP, and APACHE II scores. Continuous hemofiltration therapy could confer SAP patients with lower mortality rates.

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Section: E Pooled Results Of Items Regarding Primary Endpoints and Homentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Sensitivity Analysismentioning

confidence: 88%

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Section: Publication Biasmentioning

confidence: 99%

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Continuous Hemofiltration Reduces Mortality in Severe Acute Pancreatitis: A Meta-Analysis

Guo

Cao

et al. 2020

Emergency Medicine International

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Continuous veno-venous hemofiltration for severe acute pancreatitis

Cheng

Gong

Ding

et al. 2019

Cochrane Database of Systematic Reviews

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Pankreatitisbedingte akute Nierenschädigung (AP-AKI): Definition, Pathophysiologie, Diagnostik und Therapie

et al. 2020

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ZusammenfassungDie akute Pankreatitis (AP) stellt die häufigste gastrointestinale Ursache für Krankenhausaufnahmen dar. Die Mortalität liegt bei 5 %, kann jedoch in Abhängigkeit vom Schweregrad auf bis zu 40 % ansteigen. Insbesondere schwere Verlaufsformen sind mit einem Multiorganversagen vergesellschaftet und haben eine schlechte Prognose. In diesem Zusammenhang kann es bei bis zu 10 % der Patienten zum akuten Nierenversagen (Acute kidney injury, AKI) kommen, das sich meistens spät nach dem Versagen anderer Organe entwickelt, aber auch initial oder isoliert auftreten kann. Darüber hinaus bestimmt das AKI als Komplikation der schweren Pankreatitis maßgeblich die Prognose, da die Mortalität, vor allem bei dialysepflichtigem AKI, auf bis zu 75 % dramatisch ansteigen kann.Im Vergleich zu anderen intensivmedizinisch assoziierten AKIs (z. B. Volumenmangel, kardiales Pumpversagen, Sepsis oder Intoxikationen) weist das mit einer AP assoziierte AKI (AP-AKI) viele Gemeinsamkeiten, aber auch deutliche Unterschiede auf. Die zwei existierenden Formen des AP-AKI (initiale prärenale Schädigung aufgrund eines Volumenmangels, intrarenale Schädigung in der Spätphase) können aufeinander folgend, aber auch unabhängig voneinander auftreten. Obwohl die Pathophysiologie gänzlich unverstanden ist, scheint eine systemische und lokale entzündliche Reaktion eine wichtige Rolle zu spielen. Die frühe Diagnose und die rechtzeitige Einleitung einer effektiven supportiven und ätiopathogenetisch gerichteten Therapie kann die Prognose deutlich verbessern. Ungeachtet dessen finden sich derzeit nur wenige Studien, die sich explizit mit AKI und Pankreatitis befassen.In der vorliegenden Übersicht konzentrieren wir uns – unter Verwendung der aktuellsten Literatur – auf die zugrunde liegenden pathophysiologischen Mechanismen des AP-AKI, untersuchen in dieser Hinsicht den diagnostischen und prognostischen Stellenwert alter und neuer Serum- und Urinmarker und diskutieren die für die AP-AKI empfohlenen Behandlungsansätze inklusive möglicher Nierenersatzverfahren.

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Effect of Laparoscopic Peritoneal Lavage and Drainage and Continuous Venovenous Diahemofiltration on Severe Acute Pancreatitis

Abstract: LPLD and CVVDH are effective in the treatment of SAP by eliminating endotoxin, TNF-α, IL-6, and IL-8. The combination of CVVDH and LPLD can further improve the treatment effect.

Cited by 9 publications

References 17 publications

Continuous Hemofiltration Reduces Mortality in Severe Acute Pancreatitis: A Meta-Analysis

Continuous Hemofiltration Reduces Mortality in Severe Acute Pancreatitis: A Meta-Analysis

Continuous veno-venous hemofiltration for severe acute pancreatitis

Pankreatitisbedingte akute Nierenschädigung (AP-AKI): Definition, Pathophysiologie, Diagnostik und Therapie

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