Continuous plasma filtration adsorption for treatment of acute pancreatitis in pregnancy: analysis of 18 cases

Abstract

Objective To assess the efficacy and safety of continuous plasma filtration adsorption (CPFA) for management of acute pancreatitis in pregnancy (APIP). Methods We collected the clinical data from 18 patients with APIP treated in Chongqing Maternal and Child Health Hospital, Chongqing Emergency Center and the First Affiliated Hospital of Army Medical University between January, 2010 and November, 2016. The plasma levels of cytokines, APACHE Ⅱ score and serum amylase activity before and after CPFA, and the pregnancy outcomes of the patients were analyzed. Results The plasma levels of TNF-α, IL-1β, IL-6 and IL-10 of the patients were obviously decreased after CPFA, and no obvious changes in other cytokines were found after CPFA. The levels of TNF-α, IL-1β, and IL-6 were obviously decreased while the levels of IL-10, IL-1ra, sTNFR-I and sTNFR-Ⅱ showed no significant changes after absorption. Treatment with CPFA significantly improved the sTNFR/TNF-α ratio, increased the expression level of HLA-DR, decreased APACHE Ⅱ scores from 18.0±3.8 before treatment to 6.8±1.4, and lowered serum amylase levels. No adverse events occurred in these patients during the treatment. Follow-up for 6 months after discharge showed favorable pregnancy outcomes in all the patients, who had uneventful full-term delivery without fetal asphyxia or premature delivery. Conclusion The patients with APIP can benefit from 2 sessions of CPFA treatment, which does not adversely affect the pregnancy outcomes.

Keywords

• pregnancy
• acute pancreatitis
• hemofiltration
• blood adsorption
• cytokines