Usefulness of Interleukin-6 (IL-6) Blood Level Rapid Measurement System in the Decision of the Indication of Continuous Hemodiafiltration (CHDF) for Severe Acute Pancreatitis (SAP).
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The main pathophysiology of severe acute pancreatitis (SAP) is the deterioration of systemic inflammatory response syndrome caused by the activated cascade of humoral mediators. Cytokines such as IL-6 are thought to be a key mediator in the development of organ failure in SAP patients. Taking these into consideration, we applied continuous hemodiafiltration (CHDF) in the treatment of patients with SAP as a countermeasure against hypercytokinemia. We used rapid measurement system of IL-6 blood level with chemiluminescent enzyme immunoassay (CLEIA), with which we could measure IL-6 blood level easily within 30 minutes. The present study was undertaken to determine whether we could decide the indication of CHDF for SAP with IL-6 blood level measured using the measurement system with CLEIA. Eight SAP patients-5 men and 3 women, aged 57.4±12.7 years (mean±SD)-had their clinical course, outcome, and changes in IL-6 blood level with CLEIA evaluated. Seven of the 8 free from renal failure during ICU stays were compared for CHDF duration with the other 6 SAP patients admitted to our ICU before the measurement system was introduced. These 8 received CHDF immediately after admission because they were diagnosed as SAP with the Japanese diagnosis criteria for SAP and their IL-6 blood level reached about 400pg/ml (range: 393-7140pg/ml). The 400pg/ml in IL-6 blood level is thought to be critical for the development of organ failure in SAP patients, according to our previous study. Although mean IL-6 blood level at admission was 1760±2430pg/ml, values for all patients significantly decreased with CHDF (p<0.05) and this decrease was associated with improved clinical signs and symptoms of SAP. When IL-6 blood level decreased to 100pg/ml, CHDF was discontinued. Mean IL-6 blood level at CHDF cessation in 8 cases was 108±47.3pg/ml. Although 3 patients developed single organ failure during their ICU stay, all 8 recovered without CHDF resumption. We concluded that CHDF could be discontinued when IL-6 blood level decreased to less than 100pg/ml. These results suggest that with IL-6 rapid measurement system, we could decide the indication of CHDF for SAP scientifically. Thus, we concluded that IL-6 rapid measurement system is useful in deciding the treatment with CHDF for SAP.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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