Experience with selective plasmosorption of cfDNA/NETs in a patient with severe acute pancreatitis (case report)

Background. Modality, timing and duration of extracorporeal detoxification (ECD) in patients with severe acute pancreatitis are a controversial and unsolved problem. Objective. To evaluate safety, clinical and laboratory effectiveness of selective plasmosorption (SP) in a patient with severe acute pancreatitis. Material and methods. A 34-year-old patient presented with severe acute pancreatitis complicated by enzymatic shock. Clinical, laboratory and instrumental diagnostic methods were performed. Cell-free deoxyribonucleic acid (cfDNA) SP was used together with standard intensive therapy. The main laboratory parameters were compared. Results. SP significantly reduced the markers of systemic endogenous intoxication: CRP from 64.3 to 29.5 mg/l (54.12%) by the 4th day; leukocytes from 16.2 to 7.8∙109/l (51.85%); IL-1 from 224.1 to 16.7 pg/ml (92.55%); IL-6 from 423.4 to 84.4 pg/ml (80.1%); TNF-α from 627.2 to 102.6 pg/ml (83.64%); cfDNA from 2270 to 10 ng/ml (99.56%), band neutrophils from 18% to 11% (33.89%) by the 7th day. Acid-base state normalized by the 3rd day (pH from 7.15 to 7.31, BE from –11.2 to –2.6, lactate from 4.9 to 1.4 mmol/l). SOFA scores decreased from 6 to 1 point by the 7th day. Conclusion. SP of cfDNA quickly normalizes the main clinical and laboratory parameters, as well as markers of systemic endogenous intoxication.