Network meta-analysis ranks blood purification strategies for severe acute pancreatitis

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.