Efficacy of multimodal hemosorption in severe acute pancreatitis: a prospective pilot study

INTRODUCTION: Mortality in severe acute pancreatitis (SAP) remains high. Early multiple organ failure (MOF) is the primary factor determining disease severity and outcomes. Treatment is largely symptomatic, and the role of extracorporeal therapies remains controversial. While studies have examined cytokine adsorption and hemodiafiltration in early SAP, the inclusion of lipopolysaccharide (LPS) adsorption remains poorly understood. OBJECTIVE: To assess the impact of multimodal cytokine and LPS hemoperfusion on clinical and laboratory parameters in early-phase acute pancreatitis with MOF. MATERIALS AND METHODS: The study included 30 patients with severe acute pancreatitis. The main prospective intervention group consisted of 15 patients receiving standard therapy in combination with multimodal hemosorption. The prospective control group consisted of 15 parallel-selected patients receiving standard therapy. Clinical, laboratory, and outcome measures were compared between groups. RESULTS: Incorporation of multimodal hemoperfusion into the management of early multiple organ failure in SAP contributed to faster resolution of organ dysfunction in the study group (RMANOVA; p = 0.009). By day 3, it significantly reduced lactate concentration from 2.0 (1.3; 3.0) to 1.5 (1.2; 2.1) mmol/L (p = 0.026) and C-reactive protein from 302 (258; 405) to 220 (163; 281) mg/L (p = 0.026). In the hemoperfusion group, ICU length of stay was shorter — 13,5 (9,6; 16,1) days versus 18,9 (11; 55,8) days in the control group (p = 0.059), and total hospital stay decreased to 19 (17; 36) days compared with 25 (14; 56) days in the control group (p = 0.689). CONCLUSIONS: The use of multimodal hemoperfusion in our SAP patients was linked to faster regression of organ dysfunction and reduced inflammatory markers, yet the study lacks sufficient power to recommend its routine clinical application. To confirm the hypothesis regarding the effectiveness of multimodal hemosorption in the early phase of PTP, a larger prospective study is required.