Continuous blood purification for severe acute pancreatitis: A systematic review and meta-analysis

Abstract

Background: The incidence of acute pancreatitis (AP) is rising around the world, thus further increasing the burden on healthcare services. Approximately 20% of AP will develop severe acute pancreatitis (SAP) with persistent organ failure (>48 h), which is the leading cause of high mortality. To date, there is no specific drug in treating SAP, and the main treatment is still based on supportive care. However, some clinical control studies regarding the superiority of continuous blood purification (CBP) has been published recently. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of CBP in SAP treatment.

Methods: Four databases (Medline, SinoMed, EMBASE, and Cochrane Library) were searched for eligible studies from 1980 to 2018 containing a total of 4 randomized controlled trials and 8 prospective studies.

Results: After the analysis of data amenable to polling, significant advantages were found in favor of the CBP approach in terms of Acute Physiology and Chronic Health Evaluation II (APACHE II) score (WMD = -3.00,95%CI = -4.65 to -1.35), serum amylase (WMD = -237.14, 95% CI = -292.77 to 181.31), serum creatinine (WMD = -80.54,95%CI = 160.17 to -0.92), length of stay in the ICU (WMD = -7.15,95%CI = -9.88 to -4.43), and mortality (OR = 0.60, 95%CI = 0.38-0.94). No marked differences were found in terms of C-reactive protein (CRP), alamine aminotransferase (ALT) and length of hospital stay (LOS).

Conclusion: Compared with conventional treatment, CBP remedy evidently improved clinical outcomes, including reduced incidence organ failure, decreased serum amylase, APACHE II score, length of stay in the ICU and lower mortality rate, leading us to conclude that it is a safer treatment option for SAP. Furthermore, relevant multicenter RCTs are required to prove these findings.

Figure 1

Flow diagram for selection of studies for inclusion in this meta-analysis.

Figure 2

Forest plot (whole study) of the merits between continuous blood purification and the conventional treatment in the light of clinical outcomes. (a. APACHE II score. b. Mortality. c. Serum creatinine. d. Alamine aminotransferase. e. C-reactive protein. f. Serum amylase. g. Days in intensive care. h. Length of stay in hospital.) CI = confidence interval, OR = odds risk.

Figure 3

Forest plot (subgroup, divided by RCT and retrospective study) of the merits between continuous blood purification and the conventional treatment in the light of clinical outcomes. (a. RCT- APACHE II score. b. RCT-mortality. c. RCT-serum creatinine. d. RCT- CRP. e. retrospective study- APACHE II score. f. Retrospective study-mortality. g. Retrospective study-serum creatinine. h. Retrospective study- CRP). APACHE II = Acute Physiology and Chronic Health Evaluation II, CI = confidence interval, CRP = C-reactive protein OR = odds risk, RCT = randomized controlled trial.

Figure 4

Funnel plot of 2 intervention for outcome of mortality. OR = odds risk, SE = standard error.