Early Continuous Veno-Venous Hemofiltration Is Effective in Decreasing Intra-Abdominal Pressure and Serum Interleukin-8 Level in Severe Acute Pancreatitis Patients with Abdominal Compartment Syndrome.

OBJECTIVE

The aim of this study was to evaluate the efficacy of early continuous veno-venous hemofiltration (CVVH) in decreasing the intra-abdominal pressure (IAP) and serum interleukin-8 (IL-8) level in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS).

METHODS

Twenty-five ACS patients of SAP were enrolled in a prospective study conducted according to the standard management protocol. They were treated in the intensive care unit (ICU) of Affiliated Yidu Central Hospital of Weifang Medical College and underwent CVVH. Eleven patients were set up as the control group that received no hemofiltration and surgical treatment due to economic or other reasons but solely conventional treatment. Serum amylase, liver and kidney function, and C reactive protein were investigated before and after treatment. IAP and blood level of IL-8 were measured daily to investigate their time course of changes and the correlation between the 2 parameters.

RESULTS

Serum amylase levels, C-reactive protein and IAP were significantly lower and liver and kidney function was significantly better than those of the control group (p < 0.05). IAP on admission to the ICU was high, at 22.9 ± 2.1 mm Hg. The IAP was significantly lower to 17.2 ± 2.2 mm Hg (p < 0.01) 24 h after the initiation of CVVH, and thereafter decreased rapidly. The average blood level of IL-8 was high at 88.2 ± 25.1 ng/L on admission. However, it significantly decreased to 63.2 ± 18.7 ng/L (p < 0.01) 24 h after the initiation of CVVH, and subsequently decreased. There was a significant positive correlation between the blood level of IL-8 and IAP(r = 0.62, p < 0.01).

CONCLUSIONS

CVVH is effective to decrease the IAP and the blood level of IL-8 in ACS patients of SAP. The blood level of IL-8 was significantly correlated with IAP, suggesting that IL-8 might play an important role in the pathogenesis of ACS. Early CVVH appeared to be effective in the treatment of ACS in patients with SAP through the removal of causative cytokines such as IL-8, and it thereby decreased interstitial edema to lower IAP and should be applied in the early stage of ACS. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=480223.