Document Detail


Improvement of monocyte function and immune homeostasis by high volume continuous venovenous hemofiltration in patients with severe acute pancreatitis.
MedLine Citation:
PMID:  19009506     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Continuous renal replacement therapy (CRRT) showed promising results in the management of critically ill patients with systemic inflammatory response syndrome (SIRS)/sepsis. However, the underlying mechanism is still not very clear. A change of immune homeostasis in critically ill patients during CRRT was observed only to a smaller degree. OBJECTIVE: The purpose of this study was to test the hypothesis that high-volume continuous venovenous hemofiltration (HV-CVVH) treatment could improve monocyte function and restore immune homeostasis in patients with severe acute pancreatitis (SAP). METHODS: This was a prospective clinical trial in the surgical intensive care unit of a teaching hospital. Subjects were 16 patients with severe acute pancreatitis: sepsis group (n=7): positive culture result and in the late phase of disease (from onset of SAP to receiving CVVH therapy: more than 3 days); and nonseptic group (n=9): negative culture result and early phase of disease (less than 3 days). Patients received 72 hours of HV-CVVH. We measured the change in mean arterial pressure, APACHE II score, monocyte functions (including antigen-presenting and cytokine production ability), and plasma cytokines. RESULTS: Mean arterial pressure were stable accompanied with APACHE II score improvements. HLA-DR expression on monocytes (antigen-presenting ability) were markedly decreased (p<0.0001) in all patients. Lipopolysaccharide (LPS)-induced TNF-alpha, interleukin-6 (IL-6), and IL-10 production from patients' monocytes markedly decreased in septic patients, but significantly increased in nonseptic patients. During HV-CVVH treatment, HLA-DR expression was markedly increased in nonseptic patients in 24 hours (p<0.05), and in septic patients in 72 hours (p<0.05). LPS-induced cytokine production was decreased in nonseptic patients, but not significantly changed in septic patients. The change of plasma cytokines showed the same trend. CONCLUSIONS: In patients with SAP, HV-CVVH was associated with improved hemodynamics. HV-CVVH restores monocytes functions, especially in patients in the early phase of the disease and without sepsis. These findings suggest a potential role for HV-CVVH in the treatment of SAP.
Authors:
C Yu; Z-H Liu; Z-H Chen; D H Gong; D-X Ji; L S H Li
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The International journal of artificial organs     Volume:  31     ISSN:  0391-3988     ISO Abbreviation:  Int J Artif Organs     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-11-14     Completed Date:  2009-02-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802649     Medline TA:  Int J Artif Organs     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  882-90     Citation Subset:  IM    
Affiliation:
Department of Nephrology, East Hospital, Tongji University School of Medicine, Shanghai - PR China.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged, 80 and over
Female
HLA-DR Antigens / blood
Hemofiltration / methods*
Homeostasis
Humans
Immune System / physiology
Interleukin-10 / blood
Interleukin-6 / blood
Male
Middle Aged
Monocytes / physiology*
Pancreatitis / blood,  immunology,  therapy*
Prospective Studies
Renal Replacement Therapy*
Tumor Necrosis Factor-alpha / blood
Chemical
Reg. No./Substance:
0/HLA-DR Antigens; 0/Interleukin-6; 0/Tumor Necrosis Factor-alpha; 130068-27-8/Interleukin-10

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