ANALYSIS OF THE EFFICIENCY OF THE IMPLEMENTATION OF THE RIFLE SCALE AND EXTEND- ED KID REPLACEMENT THERAPY FOR SEVERE ACUTE PANCREATITIS

Aim. Improving the results of treatment of patients with severe acute pancreatitis with multiple organ failure and acute renal failure.Materials and methods. The cases of 140 patients who had a history of severe acute pancreatitis with symptoms of multiorgan or isolated renal insufficiency over the period 2014-2018 were analyzed. Two groups were formed: the 1st (n-80, 2016-2018) and the 2nd (n-60, 2014-2015). Of the total number of all patients, there were 85 (60.7%) man and 55 (39.3%) women, with a ratio of almost 1.5:1. The average age of the patients included in the study was 48.22 ±12.32 years in the 1st group, 47.58 ± 10.56 years in the 2nd group (p≥0.05). In the 1st group all patients with severe acute pancreatitis used to determine the severity of acute kidney damage on the RIFLE scale with the onset of efferent therapy according to the degree of organ damage: R, I, or F. The 2nd group was treated without taking the RIFLE scale (only the retrospective scaling). At the time of admission to the hospital, there was a commensurability of research groups in terms of laboratory parameters, duration of illness, and comorbid background. In group 1, the bulk were patients with severity of acute renal damage in the risk (R-R) stage, which accounted for 49 patients (61.25%). The injury stage was noted in 10 patients (12.5%), the rest were stratified into groups R-F (“disturbance”; 18 patients, 26.25%). Analysis of the clinical material of group 2 also made it possible to distribute patients according to the severity of renal damage, which was carried out on the basis of a retrospective analysis: stage “R” was noted in 41 (68.3%), “I” in 6 (10%) and “F” in 13 (21.7%) patients. Low and medium volume hemofiltration were referred to as “renal” (R-R and R-I), and high-volume methods for the treatment of the “R-F” stage.Results. According to the type of acute renal failure, all patients of group 1 were subjected to renal replacement therapy by the method of prolonged low-flow veno-venous hemodiafiltration: start of therapy at 3.0 ± 0.8 days from the moment of hospitalization. In patients of group 2, similar technologies were used only in 35 patients (58.3%), while in the remaining patients, renal replacement therapy was not performed at all. The timeline for the implementation of low-flow veno-venous hemodiafiltration in group 2 was 6.1 ± 1.0 days from the time of hospitalization (p≤0.001), mainly due to extrarenal indications. A total of 294 procedures of prolonged low-flow veno-venous hemodiafiltration were performed in the presented clinical material with distribution from 1 to 6 sessions per patient, which averaged 1.82 ± 0.87 sessions per person. The duration of sessions of efferent therapy ranged from 12 to 79 hours, which was on average 31.9 hours per patient per session. The dynamics of the compared laboratory and calculated data was identical in the studied groups, however, there was a clear tendency to more slowly decrease biochemical and manometric parameters when using lower values of convection velocity (group 2; according to retrospective analysis). In the main group of patients, there were 5 deaths (6.25%) versus 18 (30%; p≤0.05) in group 2.Conclusion. Based on our studies, we convincingly demonstrated the validity of including extended renal replacement therapy in a complex of therapeutic measures in patients with severe acute pancreatitis, as well as a dose-dependent effect on the rate of ultrafiltration and convection. Such an algorithm will significantly increase the survival rate in severe acute pancreatitis with symptoms of acute renal damage.

RIFLE, severe acute pancreatitis, acute renal failure, RIFLE, prolonged low-flow veno-venous hemodiafiltration