Coupled Plasma Filtration and Adsorption in Eliminating Inflammatory Mediators and Enhancing Sublingual Microcirculation in Severe Acute Pancreatitis.

Objective: This study aims to assess the effectiveness of coupled plasma filtration and adsorption (CPFA) in patients with SAP through its effect on inflammatory mediators and sublingual circulating blood volume. The hypothesis put to test is that CPFA can achieve a satisfactory reduction in inflammatory mediators and enhance sublingual microcirculation in SAP with a very good clinical outcome.

Methods: A cohort of 112 SAP patients admitted to the ICU of our institution between January 2018 and December 2022 was consecutively recruited. Participants were randomized to the CPFA or the control group (standard treatment) using a random number table for assignment. Post-treatment alterations in inflammatory mediators and sublingual microcirculation were analyzed and compared.

Results: Following treatment, the study group showed significantly reduced levels of IL-1β, TNF-α, and IL-6 versus the control group. Additionally, the study group witnessed lower serum and urinary amylase levels and APACHE II and SOFA scores. Parameters related to sublingual microcirculation, including Total Vessel Density (TVDs), Small Vessel Perfusion Ratio (PPVs), Perfusion Small Vessel Density (PVDs), and Microvascular Flow Index (MFIs), were significantly improved in the study group. Moreover, the study group observed lower rates of Systemic Inflammatory Response Syndrome (SIRS) and 30-day mortality versus the control group.

Conclusion: The application of CPFA in SAP patients effectively eliminates inflammatory mediators and enhances microcirculation, leading to improved clinical outcomes and reduced mortality rates.