Application of citric acid in continuous veno-venous hemofiltration of severe acute pancreatitis patients in ICU

Objective: This study aimed to investigate the effect of citric acid on anticoagulation and kidney functions in the continuous veno-venous hemofiltration (CVVH) of severe acute pancreatitis (SAP) patients in ICU as compared with the low molecular weight (LMW) heparin. Methods: 40 SAP patients admitted to ICU of our hospital from January 2017 to December 2019 were included for retrospective analysis and divided into the control group (CG, n=20) and the observation group (OG, n=20) by double-blind randomization. All patients were treated with CVVH. The difference lied in the anticoagulation that citric acid was used in the OG, and LMW heparin was used in the CG. The two groups were compared for anticoagulation effects and kidney functions. Results: (1) The APTT level was higher in the OG as compared with the CG (P<0.05) after 2 h, 6 h and 9 h of treatment. At 1 h after treatment, the APTT level changed insignificantly in the OG as compared with that before treatment (P>0.05) but elevated sharply in the CG (P<0.05). (2) PLT levels remained almost the same in the OG (P>0.05) but reduced in the CG (P<0.05) as compared with those before treatment, after treatment and at 1 d after treatment. (3) After treatment, the OG yielded lower levels of inflammatory factors, i.e., IL-6 and TNF-alpha, and kidney function indices, including Bun and Scr (P<0.05) than the CG. (4) No statistical difference was found between the two groups in terms of proportions of grades I, II and III for coagulation and bleeding at the puncturing and insertion sites (P>0.05). Conclusion: The application of citric acid in CVVH of SAP patients in ICU could achieve better anticoagulation effect and improve patients' kidney functions, which deserves popularizing.