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Removal of inflammatory mediators by continuous renal replacement therapy in severe sepsis
Critical Care volume 13, Article number: P269 (2009)
The aim of this study was to evaluate the efficacy of continuous renal replacement therapy (CRRT) in systemic inflammatory mediator removal in a group of patients with severe sepsis/septic shock and related renal failure.
We conducted a prospective study, approved by the ethics committee, enrolling 11 patients with severe sepsis/septic shock under CRRT. We measured the cytokines using the immunoassay method. The cytokine measurement was done every morning until the end of renal support. We analyzed the following data: age, severity scores (Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA)), cytokines (TNF, IL-1β, IL-6 and IL-10) levels on pre-filter, post-filter and ultrafiltrate samples. We correlated these data with filter duration, considering 24 hours as the maximum theoretical limit for effective cytokine removal.
From the 11 patients enrolled, we collected 420 valid samples to measure the cytokine levels. The mean age and SAPS II were respectively 66 ± 10.7 years and 46 ± 27.1. The mean total SOFA score at admission and at day 3 were 11.2 ± 4 and 12.7 ± 4 respectively, with ΔSOFA = +1.3 points (P > 0.05). The mean ICU hospitalization time was 25.9 ± 33.5 days. We have done 876 hours of dialytic therapy; 33 AN69 membranes were used, during a mean time of 26.5 ± 25.6 hours. The mean total levels found for cytokines are presented in Figure 1 and the levels depending on the filter duration are in Figure 2. The ICU mortality was 54.6%.
The present study does not allow us to define a specific pattern for the removal of inflammatory mediators related to CRRT. We observed a trend for cytokine reduction dependent on filter duration with the higher efficacy removal until 24 hours. The cytokine level found in the effluent does not reflect the absolute reduction found in post-filter, and this effect could be dependent on adsorption, according to other studies [1, 2].
Shoji H: Extracorporeal endotoxin removal for the treatment of sepsis: endotoxin adsorption cartridge (toraymyxin). Ther Apher Dial 2003, 7: 108-114. 10.1046/j.1526-0968.2003.00005.x
Kellum J, Song M, Venkataraman R: Hemoadsorption removes tumor necrosis factor, interleukin-6, and interleukin-10, reduces nuclear factor-B DNA binding, and improves short-term survival in lethal endotoxemia. Crit Care Med 2004, 32: 801-805. 10.1097/01.CCM.0000114997.39857.69
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Tomas, E., Lafuente, E., Vera, B. et al. Removal of inflammatory mediators by continuous renal replacement therapy in severe sepsis. Crit Care 13, P269 (2009). https://doi.org/10.1186/cc7433
- Inflammatory Mediator
- Sequential Organ Failure Assessment
- Continuous Renal Replacement Therapy
- Sequential Organ Failure Assessment Score
- Simplify Acute Physiology Score