Network meta-analysis ranks blood purification strategies for severe acute pancreatitisBlood Purification May Help Severe Pancreatitis Scores But Not Mortality

Frontiers in Medicine Published May 30, 2026 Study authors: Peihong Li, Hao Tian, Po Huang, Xiaolei Fang DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Hemoperfusion plus continuous renal replacement therapy may improve outcomes in severe acute pancreatitis, but mortality benefit remains unproven.

A systematic review and network meta-analysis evaluated blood purification strategies for severe acute pancreatitis, analyzing data from 3,707 patients. The primary outcome was the Acute Physiology and Chronic Health Evaluation (APACHE II) score, with secondary outcomes including amylase, C-reactive protein, interleukin-6, triglyceride levels, renal function, and mortality.

The analysis ranked hemoperfusion combined with continuous renal replacement therapy as the most effective intervention for improving APACHE II scores. This strategy also showed strong efficacy in reducing inflammatory markers like C-reactive protein and interleukin-6, and in improving triglyceride levels and renal function in hyperlipidemic patients.

However, blood purification modes did not demonstrate a clear mortality benefit compared to conventional therapy. The review noted limitations, including detected loop inconsistency and unresolved heterogeneity, which warrant cautious interpretation and highlight the need for further high-quality trials to confirm optimal strategies.

Despite these limitations, the findings provide evidence-based guidance for clinical decision-making in managing severe acute pancreatitis, emphasizing the potential of specific blood purification combinations to improve key physiological and inflammatory parameters.

This network meta-analysis compared different blood purification strategies against conventional therapy for patients with severe acute pancreatitis. The study included 3,707 patients from various settings, though the specific locations were not reported in the source data.

Researchers found that combining hemoperfusion with continuous renal replacement therapy ranked as the most effective intervention for lowering APACHE II scores, a measure of illness severity. Other combinations of these therapies also showed strong results for reducing markers like C-reactive protein and interleukin-6. For patients with high triglyceride levels, hemoperfusion combined with continuous renal replacement therapy showed the greatest improvement.

However, the analysis did not find a trend toward lower mortality with blood purification compared to standard care. The study authors noted that loop inconsistency was detected and heterogeneity could not be effectively resolved. They state that further high-quality trials are required to confirm the optimal blood purification strategy. Readers should interpret these findings with caution until more data is available.

What this means for you:

Blood purification improved organ function scores but did not lower death rates in severe acute pancreatitis patients.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

To evaluate the clinical efficacy of different blood purification modes on Severe Acute Pancreatitis (SAP) based on a network meta-analysis, providing new insights for clinical treatment of SAP. Computerized searches were conducted in English databases (PubMed, Embase, Cochrane Library, Web of Science) and Chinese databases (CNKI, VIP, Wangfang Data, CBM) for clinical trials published through December 1, 2025, evaluating various blood purification modes for SAP. Study quality was assessed using the RoB 2.0 (Cochrane risk of bias tool for randomized trials, version 2). Meta-analysis was performed using STATA 18.0 software under the frequentist framework with a random-effects model. Surface Under the Cumulative Ranking Curve (SUCRA) values were used to rank the efficacy of interventions. Publication bias was assessed using funnel plots, and loop inconsistency was examined for closed loops in the evidence network. A total of 45 randomized controlled trials involving 3,707 patients were included. The network meta-analysis showed that regarding the primary outcome of Acute Physiology and Chronic Health Evaluation (APACHE II) scores, hemoperfusion + continuous renal replacement therapy ranked as the most effective intervention. For secondary outcomes:continuous renal replacement therapy plus plasma exchange and hemoperfusion combined with continuous renal replacement therapy were among the most effective interventions for reducing amylase (AMS), C-reactive protein (CRP), interleukin-6 (IL-6). Hemoperfusion combined with continuous renal replacement therapy demonstrated the greatest improvement in triglyceride (TG) levels in patients with hyperlipidemic SAP, and in renal function (Scr). However, in terms of mortality outcomes, blood purification did not show a trend toward benefit compared with conventional therapy. And for certain outcomes, loop inconsistency was detected and heterogeneity could not be effectively resolved, warranting cautious interpretation. Hemoperfusion combined with continuous renal replacement therapy demonstrateds more satisfactory therapeutic effects and significantly reduces amylase levels, improves inflammatory response, renal function, and disease severity in SAP patients, and effectively lowers TG levels in those with hyperlipidemic SAP, but hemoperfusion combined with continuous renal replacement therapy does not significantly decrease mortality. These findings provide evidence-based guidance for clinical decision-making, though further high-quality trials are required to confirm the optimal blood purification strategy. https://www.crd.york.ac.uk/prospero/, identifier CRD420261403366.

Network meta-analysis ranks blood purification strategies for severe acute pancreatitisBlood Purification May Help Severe Pancreatitis Scores But Not Mortality

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Network meta-analysis ranks blood purification strategies for severe acute pancreatitisBlood Purification May Help Severe Pancreatitis Scores But Not Mortality

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