Comparison of the efficacy of continuous i.v. infusion versus continuous regional arterial infusion of nafamostat mesylate for severe acute pancreatitis

Abstract

Aim: Continuous regional arterial infusion (CRAI) of protease inhibitors may be effective in the treatment of severe acute pancreatitis (SAP), but it is more invasive than i.v. infusion. The purpose of this study was to examine the effectiveness of continuous i.v. infusion (CIVI) for SAP compared with CRAI by unifying the dose and the administration period of nafamostat mesylate.

Methods: This study comprised 32 patients with SAP who were divided into two groups: the CRAI group and the CIVI group. The protease inhibitor, nafamostat mesylate, was continuously infused at a rate of 200 mg/day for 5 days in both groups. Clinical outcomes including in-hospital mortality were examined.

Results: There were no significant between-group differences in in-hospital mortality and 90-day mortality. The duration from admission to treatment was significantly shorter in the CIVI group (median, 7 h vs. 2 h, P = 0.0001; CRAI group vs. CIVI group). The rate of mechanical ventilation was significantly less in the CIVI group than in the CRAI group (93% vs. 47%, P = 0.007). The CIVI group showed a tendency toward decreased length of intensive care unit stay (median, 13 days vs. 4 days, P = 0.085) and hospital stay (median, 19 days vs. 11 days, P = 0.072). Total costs during hospitalization were significantly lower in the CIVI group (median, $18,320 vs. $11,641, P = 0.049).

Conclusion: The effectiveness of CIVI with early nafamostat mesylate treatment after the development of SAP could be equivalent to, or better than, that of CRAI.

Keywords: Continuous intravenous infusion; continuous regional arterial infusion; nafamostat mesylate; protease inhibitor; severe acute pancreatitis.

Figure 1

Time‐course from onset of acute pancreatitis to treatment. Time from onset to admission (A), time from admission to treatment (B), and time from onset to treatment (C) were investigated. White columns represent data for continuous regional arterial infusion (CRAI) and gray columns for continuous i.v. infusion (CIVI) of nafamostat mesylate. Lines denote median values, boxes represent 25th to 75th percentiles, and whiskers indicate the range.

Figure 2

Changes in clinical parameters of acute pancreatitis. Prognostic factor, Sequential Organ Failure Assessment (SOFA) score, and disseminated intravascular coagulation (DIC) score before and after continuous regional arterial infusion (CRAI; white columns) or continuous i.v. infusion (CIVI; gray columns). Lines denote median values, boxes represent 25th to 75th percentiles, and whiskers indicate the range.