{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:59:34Z","timestamp":1785769174615,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T00:00:00Z","timestamp":1758412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Severe acute pancreatitis (SAP) presents with Multiple Organ Dysfunction Syndrome (MODS) in ~15% of cases, accounting for ~35% of early deaths within 48 h. Major complications\u2014shock, renal failure, and respiratory insufficiency\u2014arise from an overwhelming systemic inflammatory response driven by markedly elevated pro-inflammatory cytokines. Massive release of IL-2, IL-6, and TNF-\u03b1 underlies the systemic inflammatory response syndrome (SIRS). Continuous veno-venous hemofiltration (CVVH) with the oXiris filter, adsorbing endotoxins and cytokines, has been used in sepsis and applied early in SAP to reduce cytokine load and organ injury. Aims: To evaluate the efficacy and safety of early CVVH with the oXiris filter in modulating the systemic inflammatory response by removing toxic cytokines from the bloodstream in patients with SAP complicated by organ dysfunction and refractory sepsis. Methods: This single-centre, retrospective, observational study was conducted at a tertiary university hospital between 2000 and 2022. Forty-eight consecutive patients with SAP at onset, defined according to the 2012 Atlanta Classification, with an APACHE II score \u2265 19 and persistent organ dysfunction (&gt;48 h), were included. All patients were unresponsive to initial intensive care within the first 24 h and underwent urgent laparotomy with extensive peritoneal lavage, pancreatic necrosectomy, and placement of multiple abdominal drains, followed by transfer to the intensive care unit. CVVH (Prismax system) with the oXiris filter was initiated within 12 h post-surgery. IL-6 and TNF-\u03b1 were selected as inflammatory markers and measured in both serum and ultrafiltrate at baseline (0 h) and at 24, 48, 72, and 96 h. These measurements were correlated with clinical parameters and prognostic scores (APACHE II, SOFA). Results: Treatment was well tolerated in all patients. The 28-day survival rate was 97.9%. There was a significant time-dependent decrease in IL-6 (p = 0.019) and TNF-\u03b1 (p = 0.008) concentrations in the ultrafiltrate, consistent with high early adsorption followed by a reduced cytokine burden, whereas serum levels showed a non-significant downward trend (IL-6 p = 0.08; TNF-\u03b1 p = 0.310). The APACHE II score decreased from 23 postoperatively to 8 by the second week (\u221265.2%; p = 0.013), with a statistically significant correlation between cytokine reduction and clinical improvement. Adverse events were rare and manageable. Conclusions: Early CVVH with the oXiris filter in SAP, complicated by MODS and refractory sepsis, proved safe, well-tolerated, and potentially effective in reducing cytokine burden and improving prognostic indices. These findings support the hypothesis of a relevant immunomodulatory effect, warranting prospective controlled trials to confirm its true impact on survival and organ recovery.<\/jats:p>","DOI":"10.3390\/jcm14186647","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T12:08:03Z","timestamp":1758542883000},"page":"6647","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Value of Continuous Hemofiltration in Patients with Severe Acute Pancreatitis at Onset: Single Centre Experience on 48 Patients"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3694-1761","authenticated-orcid":false,"given":"Paolina","family":"Saullo","sequence":"first","affiliation":[{"name":"Department of Surgery, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4683-2756","authenticated-orcid":false,"given":"Roberto","family":"Caronna","sequence":"additional","affiliation":[{"name":"Department of Surgery, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto Maria","family":"Angelici","sequence":"additional","affiliation":[{"name":"Department of Surgery, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1778-9399","authenticated-orcid":false,"given":"Valerio","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Liberatori","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Policlinico Casilino, 00169 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5437-9085","authenticated-orcid":false,"given":"Andrea","family":"Mingoli","sequence":"additional","affiliation":[{"name":"Department of Surgery, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5408-4380","authenticated-orcid":false,"given":"Piero","family":"Chirletti","sequence":"additional","affiliation":[{"name":"Department of Surgery, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13017-019-0247-0","article-title":"2019 WSES guidelines for the management of severe acute pancreatitis","volume":"14","author":"Tolonen","year":"2019","journal-title":"World J. Emerg. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1080\/13651820701329225","article-title":"Continuous veno-venous haemofiltration in the treatment of severe acute pancreatitis: 6-year experience","volume":"9","author":"Pupelis","year":"2007","journal-title":"HPB"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e14873","DOI":"10.1097\/MD.0000000000014873","article-title":"Continuous blood purification for severe acute pancreatitis: A systematic review and meta-analysis","volume":"98","author":"Hu","year":"2019","journal-title":"Medicine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"13879","DOI":"10.3748\/wjg.v20.i38.13879","article-title":"Treatment of severe acute pancreatitis and its complications","volume":"20","author":"Zerem","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_5","first-page":"237","article-title":"Effects of early hemofiltration on organ function and intra-abdominal pressure in severe acute pancreatitis patients with abdominal compartment syndrome","volume":"91","author":"Xu","year":"2019","journal-title":"Clin. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1053\/j.gastro.2010.06.010","article-title":"Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis","volume":"139","author":"Petrov","year":"2010","journal-title":"Gastroenterology"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Li, Y., Sun, P., Chang, K., Yang, M., Deng, N., Chen, S., and Su, B. (2022). Effect of continuous renal replacement therapy with the oXiris hemofilter on critically ill patients: A narrative review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11226719"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s13054-023-04555-x","article-title":"Continuous renal replacement therapy with the adsorptive oXiris filter may be associated with the lower 28-day mortality in sepsis: A systematic review and meta-analysis","volume":"27","author":"Wang","year":"2023","journal-title":"Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Zhou, Y., Wu, C., Ouyang, L., Peng, Y., Zhong, D., Xiang, X., and Li, J. (2022). Application of oXiris-continuous hemofiltration adsorption in patients with sepsis and septic shock: A single-centre experience in China. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.1012998"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10S1103C","DOI":"10.1681\/ASN.20213210S1103c","article-title":"CRRT with the oXiris filter attenuates IL-6 in a patient with severe COVID-19","volume":"32","author":"Tang","year":"2021","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1111\/sdi.12951","article-title":"Filter life and safety of heparin-grafted membrane for continuous renal replacement therapy: A randomized controlled trial","volume":"34","author":"Wong","year":"2021","journal-title":"Semin. Dial."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Broman, M.E., Hansson, F., Vincent, J.L., and Bodelsson, M. (2019). Endotoxin and cytokine reducing properties of the oXiris membrane in patients with septic shock: A randomized crossover double-blind study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0220444"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.cjtee.2024.12.003","article-title":"Comparative efficacy of two hemopurification filters for treating intra-abdominal sepsis: A retrospective study","volume":"28","author":"Zhou","year":"2025","journal-title":"Chin. J. Traumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e19632","DOI":"10.1097\/MD.0000000000019632","article-title":"Early use of endotoxin absorption by oXiris in abdominal septic shock: A case report","volume":"99","author":"Wei","year":"2020","journal-title":"Medicine"},{"key":"ref_15","first-page":"2720","article-title":"Effectiveness of continuous veno-venous hemofiltration in the treatment of severe acute pancreatitis","volume":"17","author":"Chen","year":"2019","journal-title":"Exp. Ther. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1111\/aor.14016","article-title":"High-volume hemofiltration reduces short-term mortality with no influence on the incidence of MODS, hospital stay, and hospitalization cost in patients with severe acute pancreatitis: A meta-analysis","volume":"45","author":"Huang","year":"2021","journal-title":"Artif. Organs"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6474308","DOI":"10.1155\/2020\/6474308","article-title":"Continuous hemofiltration reduces mortality in severe acute pancreatitis: A meta-analysis","volume":"2020","author":"Guo","year":"2020","journal-title":"Emerg. Med. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4815","DOI":"10.3748\/wjg.v11.i31.4815","article-title":"Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis","volume":"11","author":"Jiang","year":"2005","journal-title":"World J. Gastroenterol."},{"key":"ref_19","first-page":"CD012959","article-title":"Continuous veno-venous hemofiltration for severe acute pancreatitis","volume":"10","author":"Lin","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e27641","DOI":"10.1097\/MD.0000000000027641","article-title":"Effect of continuous hemofiltration on severe acute pancreatitis with different intra-abdominal pressure: A cohort study","volume":"100","author":"Xie","year":"2021","journal-title":"Medicine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1749-7922-4-45","article-title":"Clinical effects of laparotomy with perioperative continuous peritoneal lavage and postoperative hemofiltration in patients with severe acute pancreatitis","volume":"4","author":"Caronna","year":"2009","journal-title":"World J. Emerg. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/01.mpa.0000437321.06857.fc","article-title":"Short-term continuous high-volume hemofiltration on clinical outcomes of severe acute pancreatitis","volume":"43","author":"Guo","year":"2014","journal-title":"Pancreas"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"6073","DOI":"10.12998\/wjcc.v11.i26.6073","article-title":"Continuous renal replacement therapy with oXiris\u00ae in patients with hematologically malignant septic shock: A retrospective study","volume":"11","author":"Wang","year":"2023","journal-title":"World J. Clin. Cases"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"102572","DOI":"10.1016\/j.clinre.2025.102572","article-title":"Effects of continuous venous-venous hemofiltration with or without hemoperfusion on patients with hypertriglyceride acute pancreatitis","volume":"49","author":"Wang","year":"2025","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"352","DOI":"10.5144\/0256-4947.2015.352","article-title":"High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis: A controlled pilot study","volume":"35","author":"Sun","year":"2015","journal-title":"Ann. Saudi Med."},{"key":"ref_26","first-page":"2523","article-title":"Efficacy of continuous renal replacement therapy in the treatment of severe acute pancreatitis associated acute respiratory distress syndrome","volume":"18","author":"Cui","year":"2014","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"7575231","DOI":"10.1155\/2022\/7575231","article-title":"Effect of early continuous veno-venous haemofiltration in severe acute pancreatitis for the prevention of local pancreatic complications","volume":"2022","author":"Yadav","year":"2022","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Mielnicki, W., Dyla, A., Zaj\u0105c, M., Rokicka-Demitraszek, N., and Smeraka, J. (2024). Does continuous renal replacement therapy with oXiris in septic shock have any positive impact? Single-centre experience with oXiris therapy in septic shock patients. J. Clin. Med., 13.","DOI":"10.3390\/jcm13247527"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e258126","DOI":"10.1136\/bcr-2023-258126","article-title":"Continuous renal replacement therapy in combination with oXiris haemofilter in a paediatric patient with sodium valproate-induced acute pancreatitis","volume":"18","author":"Wang","year":"2025","journal-title":"BMJ Case Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6647\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:46:37Z","timestamp":1760035597000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,21]]},"references-count":29,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186647"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186647","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,21]]}}}