Journal of Hainan Medical University 2016; 22(6):
1
Journal of Hainan Medical University
http://www.jhmuweb.net/
Effect of early bedside hemofiltration on systemic inflammatory state
as well as liver and kidney function in patients with severe acute
pancreatitis
Bi-Bo Tang1, Dong-Hui Hu2
Intensive Care Unit, Hubei Zhongshan Hospital, Wuhan City, Hubei Province, 430033, China
Department of Liver Disease, Hubei Zhongshan Hospital, Wuhan City, Hubei Province, 430033, China
1
2
ARTICLE INFO
ABSTRACT
Article history:
Received
Received in revised form
Accepted
Available online
Objective: To evaluate the systemic inflammatory state as well as liver and kidney function in
patients with severe acute pancreatitis after early bedside hemofiltration. Methods: A total of
95 patients with severe acute pancreatitis were randomly divided into observation group with
48 cases and control group with 47 cases. Control group received routine therapy, observation
group received early bedside hemofiltration on the basis of routine therapy, and then differences
in the systemic inflammatory state as well as liver and kidney function were compared between
two groups. Results: Serum IL-22, IL-1毬, PCT and CRP levels of observation group after
treatment were lower than those of control group (P<0.05); serum TBiL, AKP and GGT levels
as well as urine BUN, CRE, ALB and 毬2-MG levels of observation group after treatment
were lower than those of control group (P<0.05). Conclusions: Early bedside hemofiltration
can reduce the systemic inflammatory state and optimize the liver and kidney function in
patients with severe acute pancreatitis, and it has positive clinical significance.
Keywords:
Severe acute pancreatitis
Bedside hemofiltration
Systemic inflammatory state
Liver and kidney function
1. Introduction
order to filter toxins and abundant moisture from the blood, and
some scholars have currently put forward that hemofiltration can
be applied to the treatment of severe acute pancreatitis, which filters
Severe acute pancreatitis is one of the diseases with the highest
abundant pancreatin and inflammatory factors from the blood to
clinical case fatality rate, massive self pancreatin digestion and
restore homeostasis[4]. In the study, early bedside hemofiltration was
systemic inflammatory state are its characteristics, and multiple
applied in the treatment of patients with severe acute pancreatitis
organ dysfunction syndrome (MODS) can occur in early stage
who were treated in our hospital, and the effect of the treatment on
of the disease and cause liver and kidney function and even lung
inflammatory state as well as liver and kidney function in patients
function failure[1]. Both domestic and foreign studies have put
was mainly stated.
forward that the early intervention of high blood circulation
concentration-related secretion factor levels in patients with severe
acute pancreatitis is expected to improve treatment outcome and
improve the clinical cure rate[2,3]. Early bedside hemofiltration was
originally used for the treatment of patients with kidney failure in

Corresponding author: Dong-Hui Hu, Hubei Zhongshan Hospital, No. 26,
Zhongshan Avenue, Qiaokou District, Wuhan City, Hubei Province, 430033, China.
Tel: 13545340275
Fund project: Hubei Provincial Natural Science Foundation No: JX5B39.
2. Materials and methods
2.1. Case information
A total of 95 patients with severe acute pancreatitis who were
treated in our hospital from September 2011 to September 2015
were included in the study, conformed to the standard of disease
2
Bi-Bo Tang & Dong-Hui Hu./ Journal of Hainan Medical University 2016; 22(6):
diagnosis established by Chinese Medical Association, and signed
determine the urine albumin (ALB) level and ELISA method was
informed consent. Those with organic disease, immune system
used to determine 毬2 microglobulin (毬2-MG) level.
disease and mental illness were excluded. 95 patients were divided
into two groups according to random number table, observation
2.4. Statistical methods
group 48 cases included 26 male cases and 22 female cases, they
were 24-70 years old, the average age was (50.28±8.12) years,
Data obtained in the study was analyzed by SPSS23.0 software,
interval between onset and clinic time was 1-9 h and the average
measurement data was in terms of mean±sd, comparison between
interval was (3.82±0.49) h; control group 47 cases included 25 male
two groups was performed by t test, and P<0.05 was set as the
cases and 22 female cases, they were 23-71 years old, the average
standard of statistical significant differences.
age was (51.39±8.52) years, interval between onset and clinic time
was 2-10 h and the average interval was (4.02±0.58) h. The two
groups showed no statistically difference in gender, age and clinic
3. Results
time distribution (P>0.05) and they were comparable.
3.1. Serum inflammatory factors
2.2. Treatment methods
Control group received clinical routine therapy for severe
pancreatitis, including fasting, gastrointestinal decompression,
parenteral nutrition, pancreatic secretion inhibition, spasmolysis,
analgesia, promoting blood circulation to remove blood stasis, etc.
Observation group received early bedside hemofiltration on the
basis of routine therapy. Instrument: PRISMA blood purification
Serum IL-22, IL-1毬, PCT and CRP levels were not statistically
different between two groups before treatment (P>0.05), serum IL22, IL-1毬, PCT and CRP levels of both groups after treatment
were lower than those before treatment and the decreasing trend of
observation group was more obvious (P<0.05), and serum IL-22,
IL-1毬, PCT and CRP levels of observation group after treatment
were lower than those of control group (P<0.05), shown in Table 1.
device, start time of filtration: within 48 h after diagnosis. Doublelumen tubes were embedded in femoral vein and then continuous
3.2. Liver function indexes
venous hemofiltration was performed at displacement fluid velocity
Serum liver function indexes TBiL, AKP and GGT levels were not
of 3 L/h for continuous 5 d.
statistically different between two groups before treatment (P>0.05),
2.3. Observation indexes
serum TBiL, AKP and GGT levels of both groups after treatment
were lower than those before treatment and the decreasing trend of
Fasting peripheral venous blood was extracted from two groups of
observation group was more obvious (P<0.05), and serum TBiL,
patients before treatment and 1d after treatment, let stand for 30min
AKP and GGT levels of observation group after treatment were
at room temperature and centrifuged at low speed, and serum was
lower than those of control group (P<0.05), shown in Table 2.
collected and cryopreserved in -70 ℃ refrigerator for detection;
urine was collected from the patients. 1) Inflammatory factors:
3.4. Kidney function indexes
enzyme-linked immunosorbent assay was used to determine serum
interleukin-22 (IL-22), interleukin-1毬 (IL-1毬), procalcitonin
(PCT) and C-reactive protein (CRP); 2) liver function: total bilirubin
Urine kidney function indexes BUN, CRE, ALB and 毬2-MG
levels were not statistically different between two groups before
(TBiL), alkaline phosphatase (AKP) and glutamyl transferase
(GGT); 3) renal function: automatic biochemical analyzer was used
treatment (P>0.05), urine BUN, CRE, ALB and 毬2-MG levels of
both groups after treatment were lower than those before treatment
to determine urine BUN and CRE levels, RIA method was used to
and the decreasing trend of observation group was more obvious
Table 1
Comparison of serum inflammatory factor levels before and after treatment.
Groups
Observation group
Control group
t
P
Case No.
48
47
IL-22 (μg/mL)
Before
After
treatment
treatment
12.48±1.53
4.38±0.51
12.72±1.49
10.93±1.76
0.162
7.394
>0.05
<0.05
IL-1毬 (pg/mL)
Before
After t
treatment
reatment
0.29±0.03
0.12±0.02
0.28±0.03
0.21±0.03
0.115
5.192
>0.05
<0.05
PCT (ng/mL)
Before
After
treatment
treatment
3.27±0.42
0.63±0.07
3.41±0.48
2.76±0.31
0.139
5.372
>0.05
<0.05
CRP (mg/L)
Before
After t
treatment
reatment
23.18±3.75
5.72±0.61
24.35±3.16
18.93±2.42
0.152
8.394
>0.05
<0.05
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Bi-Bo Tang & Dong-Hui Hu./ Journal of Hainan Medical University 2016; 22(6):
(P<0.05), and urine BUN, CRE, ALB and 毬 2-MG levels of
observation group after treatment were lower than those of control
bedside hemofiltration was applied in the treatment of patients with
group (P<0.05), shown in Table 3.
inflammatory factors were observed at first[8]. After detection, it
severe acute pancreatitis, and the changes in levels of systemic
was found that serum levels of inflammatory factors such as IL-22,
IL-1毬, PCT and CRP of observation group greatly reduced after
4. Discussion
treatment, which directly indicated the positive role of hemofiltration
in alleviating the systemic inflammatory state in patients. CRP is
Severe acute pancreatitis has dangerous conditions and higher
an acute phase protein and its level is directly proportional to the
case fatality rate, and with the improvement of medical and surgical
overall degree of inflammation. PCT is a new inflammatory index
treatment technology in nearly 10 years, the cure rate of severe acute
with more application at present, and both sensitivity and specificity
pancreatitis is improved, but foreign research shows that the overall
are higher. IL-1毬is a typical proinflammatory factor that can induce
mortality of the disease is still as high as 17%. Most patients with
severe acute pancreatitis died in the early stage of disease, so early
neutrophils to continuously release inflammatory factors such as
IL-6 and TNF-毩α[9,10]. IL-22 is a cytokine of IL-10 family that has
diagnosis and aggressive treatment is the key to reverse disease
tissue repair effect, and high expression of IL-22 receptors has been
progression and optimize disease outcome. The occurrence of severe
found in the rat model with acute pancreatitis, which may be because
acute pancreatitis is because that the increased pancreatic duct
that the pancreatic injury increases compensatory expression of IL-
pressure and exploded pancreatin secretion lead to the autodigestion
22 and promotes tissue repair. In the study, IL-22 levels decreased
tissue [5] .
In the case of acute
after treatment, which might be because that the secretion of other
pancreatitis, many other enzyme systems are activated, including
damage-promoting types of inflammatory factors decreased and the
collagenase, elastase, proteolytic enzymes, lipase, etc., it has been
amount for IL-22 to repair tissue correspondingly decreased.
of pancreatic and surrounding
found in animal models that the levels of a variety of enzymes
In addition to systemic inflammatory state, the serious harmfulness
are positively correlated with the disease severity, and negatively
of severe acute pancreatitis is reflected in the early damage to liver
correlated with the treatment outcome, and therefore, reducing the
and kidney function. Literature report shows that the degree of liver
levels of enzymes and inflammatory factors in body fluids is the
and kidney function damage in patients with acute pancreatitis is
most reliable way to quickly alleviate the illness[6].
positively correlated with the illness, and liver and kidney failure
Hemofiltration is the most widely used way in patients with
is one of the most common causes of death in patients with acute
chronic renal failure, which filters the high levels of toxins and
pancreatitis[11]. At the same time of lowering systemic inflammatory
moisture hard to be discharged in the blood so as to restore normal
factor levels, the effect of hemofiltration on liver and kidney function
blood circulation in patients[7]. At present, it has been proposed
was answered in the study by detecting the values of liver and
that hemofiltration be used for the treatment of severe acute
kidney function-related indexes. The above research results showed
pancreatitis, but it is currently restricted to case reports, and there
that serum liver function indexes TBiL, AKP and GGT levels of
is still not much relevant systemic clinical research. In the study,
observation group significantly decreased after treatment, and urine
Table 2
Comparison of liver function index values before and after treatment.
Groups
Case No.
Observation group
Control group
t
P
48
47
TBiL (μmol/L)
Before treatment After treatment
36.28±4.03
5.73±0.69
37.14±4.12
30.61±3.89
0.162
8.274
>0.05
<0.05
AKP (U/L)
Before treatment After treatment
113.28±10.71
52.17±5.39
115.36±11.27
94.35±10.02
0.216
9.783
>0.05
<0.05
GGT (U/L)
Before treatment After treatment
147.29±16.34
39.72±4.95
151.42±17.59
113.26±14.07
0.189
11.274
>0.05
<0.05
Table 3
Comparison of kidney function index values before and after treatment.
Groups
Observation
group
Control group
t
P
Case No.
BUN (mmol/L)
Before
After
treatment
treatment
CRE (μmol/L)
Before
After
treatment
treatment
48
15.48±1.77
6.54±0.71
153.47±18.95
47
15.61±1.89
0.182
>0.05
12.41±1.83
7.394
<0.05
156.03±17.82 127.43±15.73
0.283
11.283
>0.05
<0.05
73.18±8.43
ALB (mg/L)
Before
After
treatment
treatment
201.73±27.94
69.36±7.11
205.62±26.81 131.49±17.66
0.179
12.465
>0.05
<0.05
毬2-MG (mg/mL)
Before
After
treatment
treatment
27.49±3.12
6.25±0.74
28.38±3.34
0.217
>0.05
17.39±2.13
9.302
<0.05
4
Bi-Bo Tang & Dong-Hui Hu./ Journal of Hainan Medical University 2016; 22(6):
kidney function indexes BUN, CRE, ALB and 毬2-MG levels also
significantly decreased, explaining that at the same time of lowering
no benefits in severe acute pancreatitis with early organ failure: a
inflammatory factor levels, hemofiltration could also optimize the
[5] Xiong R. Effect of ecological immune enteral nutrition intervention on
liver and kidney function[12].
Foreign scholars have proposed that there is be direct correlation
between excessive inflammatory response and liver dysfunction,
retrospective case-matched study. Artif Organs 2014; 38(4): 335-341.
intestinal barrier function and systemic inflammatory response in rat
models with severe pancreatitis. J Hainan Med Univ 2016; 22(3): 212214.
and inflammatory factors retrograde via common bile duct to invade
[6] Xu J, Tian X, Zhang C, et al. Management of abdominal compartment
the liver; pancreatic edema oppresses bile duct and causes a certain
syndrome in severe acute pancreatitis patients with early continuous
degree of obstruction and cholestasis; endotoxemia can damage
veno-venous hemofiltration. Hepatogastroenterology 2013; 60(127): 1749-
the capillaries in the liver. Hemofiltration discharges excessively
1752.
secreted inflammatory factors out of the body via venous blood,
[7] Chu LP, Zhou JJ, Yu YF, et al. Clinical effects of pulse high-volume
lower the body's stress response and reduce pancreatic edema, the
hemofiltration on severe acute pancreatitis complicated with multiple
liver damage caused by systemic inflammation and edematous
organ dysfunction syndrome.Ther Apher Dial 2013; 17(1): 78-83.
pancreas oppression is eased, and this is the internal reason of the
[8] Aleksandrova IV, Il'inskiĭ ME, Reĭ SI, Berdnikov GA, et al. Permanent
declined liver function damage and optimized related indexes[13,14].
venovenous hemofiltration in the complex therapy of severe acute
Septic shock caused by severe acute pancreatitis can lead to the
pancreatitis. Anesteziol Reanimatol 2011; 7(3): 54-58.
decrease of systemic vascular resistance and vascular reactivity, and
[9] Zhang HY, Song Z, Li B, et al. The curative effect of coupled plasma
cause decreased renal perfusion and reduced glomerular filtration
filtration adsorption combined with high volume hemofiltration for senile
rate, and in addition, high levels of inflammatory factors will directly
severe acute pancreatitis and the effect on inflammatory factors. Chin J
cause kidney damage. Many studies have confirmed that the patients
Gerontol 2015; 35(16): 4589-4591.
with severe acute pancreatitis are accompanied by decline in renal
[10]Basios N, Lampropoulos P, Papalois A, et al. Apigenin attenuates
function and renal failure, which directly increase the difficulty in
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inflammatory response in patients with severe acute pancreatitis,
[11]Merza M, Hartman H, Rahman M, et al. Neutrophil extracellular traps
hemofiltration has cleared the proinflammatory factors in the blood
induce trypsin activation, inflammation, and tissue damage in mice with
and reduce the risk of multiple organ dysfunction syndrome.
severe acute pancreatitis. Gastroenterology 2015; 149(7): 1920-1931.
To sum up, early bedside hemofiltration can reduce the systemic
[12]Hou SG, Li YZ, Zhang YH, et al. Curative effect observation of Ornithine
inflammatory state and optimize the liver and kidney function in
Aspartate for prevention and treatment of liver function damage in severe
patients with severe acute pancreatitis, and it’s worth popularization
and application in clinical practice in the future.
acute pancreatitis. J Clin Hepatol 2016; 19(2): 227-229.
[13]Sharma V, Rana SS, Sharma RK, et al. A study of radiological scoring
system evaluating extrapancreatic inflammation with conventional
radiological and clinical scores in predicting outcomes in acute
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