Abstract
Much previous research agrees that inflammatory mediators and cytokines play an important role in acute pancreatitis progression. Acute pancreatitis is a common internal disease causing systemic inflammatory response syndrome (SIRS) induced by hypercytokinemia. In Japan, blood purification therapy is recognized a special treatment for severe acute pancreatitis (SAP). The new Japanese severity score for SAP proposed in 1998 included the presence of 3 or more of clinical conditions of SIRS as a prognostic factor. To investigate efficacy of our treatment adding continuous hemodiafiltration (CHDF) to SAP and to evaluate the new severity score for SAP, we studied 16 consecutive patients diagnosed with SAP at critical care emergency center. Severity scores on admission and 5 days after admission were compared to duration of ICU stay by the Spearman rank correlation coefficient. Relationships between scoring parameters divided into 2 groups by mean value and duration of ICU stay were assessed by the log rank test. Relationships between categoric factors were analyzed by the Chi-square test. CHDF was introduced to 10 patients. Survival was 93.8% in all patients, and 90.0% in CHDF patients. Both severity scores on admission and 5 days after admission were significantly related with duration of ICU stay. Among parameters, the presence of clinical symptoms and a decrease in base excess correlated significantly with prolonged duration of ICU stay. We found that CHDF is useful in SAP treatment. The severity score is useful in evaluating SAP severity on admission, and is helpful in early appropriate treatment based on the patient's clinical condition. Both the presence of clinical symptoms and decreased base excess on admission are important parameters for the clinical course after admission. This score may also be a beneficial predictor in the course of treatment.
