Blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration for patients with multiple organ dysfunction syndrome

doi:10.5847/wjem.j.issn.1920-8642.2012.01.008

Abstract

Abstract:

BACKGROUND: Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration (CVVH). Hence blood hemoperfusion with resin adsorption combined CVVH (HP+CVVH) has higher ability of mediator clearance, and can improve clinical outcomes in theory. This study aimed to investigate the effect of blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration (HP+CVVH) on plasm cytokines like TNF-α, IL-1β, IL-6, cellular immunity and prognosis in patients with multiple organ dysfunction syndrome (MODS).

METHODS: This was a prospective, randomized clinical trial. A total of 30 patients who had been diagnosed with MODS were enrolled in this study. Patients were randomly allocated to routine treatment+HP+CVVH group (treatment group) and routine treatment+only CVVH group (control group). In the treatment group, patients received blood hemoperfusion with resin adsorption for 2 hours, and then received CVVH for 10 hours every day. In the control group, patients received CVVH for 12 hours only every day. The patients in the two groups received blood purification therapy for three days. The plasma of patients in the treatment group was obtained at 0, 2, 12, 24, 26, 36, 48, 50, 60 hours, 5th day, 7th day and 10th day, respectively. The plasma of patients in the control group was obtained at 0, 12, 24, 36, 48, 60 hours, 5th day, 7th day and 10th day, respectively. APACHE II score, T-lymphocytes subpopulations, blood lactate acid concentration, heart rate, breathing rate, and oxygenation index were observed.

RESULTS: Plasma cytokines like TNF-α, IL-1β, IL-6 decreased markedly after HP (P<0.01); T-lymphocytes subpopulations CD3+, CD4+, CD8+, CD4+/CD8+ increased after HP+CVVH or only CVVH. The plasma concentrations of TNF-α, IL-1β and IL-6 in the two groups were not markedly different at 12, 36, and 50 hours. But on the 5th day, the plasma concentrations of TNF-α, IL-1β and IL-6 in the treatment group were lower than those in the control group (P<0.05). On the 28th day, 5 patients died in the treatment group, and 6 patients in the control group.

CONCLUSIONS: Both HP+CVVH and CVVH can clean plasma cytokines like TNF-α, IL-1β, and IL-6, and improve cellular immunity and clinical symptoms and signs of patients. Compared with only CVVH, the plasma concentrations of TNF-α, IL-1β and IL-6 were lower on the 5th day, and patients have an increased survival rate on the 28 day in the HP+CVVH group.

Key words: Hemoperfusion with resin adsorption, Continuous veno-venous hemofiltration, Multiple organ dysfunction syndrome, Cytokines

Lu-yi Liu, Yong-jian Zhu, Xiao-li Li, Ya-feng Liang, Zuo-peng Liang, Yong-hong Xia. Blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration for patients with multiple organ dysfunction syndrome[J]. World Journal of Emergency Medicine, 2012, 3(1): 44-48.

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Time points (h)	TNF-α (mol/L)		IL-6 (ng/L)		IL-1β (ng/L)
Time points (h)	Treatment group	Control group	Treatment group	Control group	Treatment group	Control group
0	20.30±8.73	21.04±4.63	60.23±22.34	58.58±21.80	0.14±0.06	0.12±0.03
2	15.98±5.11^*		58.65±23.10^*		0.09±0.05^*
12	16.05±6.33	18.70±4.65^Δ	42.32±21.57^#	44.74±20.31^Δ	0.09±0.05	0.09±0.02^Δ
24	18.52±8.58	18.25±6.20	59.27±20.65	54.73±31.80	0.15±0.05	0.16±0.02
26	15.62±6.67^*		56.23±24.31^*		0.11±0.05^*
36	13.31±4.53	16.19±6.23^Δ	48.03±20.14^#	46.05±29.79^Δ	0.11±0.05	0.11±0.04^Δ
48	15.41±6.52	17.00±4.81	55.45±26.14	62.89±43.58	0.13±0.05	0.09±0.05
50	12.89±6.19^*		54.13±22.10^*		0.09±0.03^*
60	15.59±9.18	15.27±4.65^Δ	50.12±18.14^#	44.58±21.83^Δ	0.09±0.03	0.08±0.04^Δ

Time points	0	24 h	48 h	5th day	7th day	10th day
TNF-α (mol/L)
Treatment group	20.30±8.73	18.52±8.58	15.41±6.52	11.91±4.32	12.20±3.90	11.66±3.44
Control group	21.04±4.63	18.25±6.20	17.00±4.81	15.60±4.73^*	14.89±4.45	13.27±4.49
IL-6 (ng/L)
Treatment group	60.23±22.34	59.27±20.65	55.45±26.14	46.12±22.16	47.10±29.90	40.12±19.23
Control group	58.58±21.80	54.73±31.80	55.89±43.58	49.63±25.43^*	44.70±19.82	39.42±24.76
IL-1β (ng/L)
Treatment group	0.14±0.06	0.15±0.05	0.13±0.05	0.13±0.11	0.08±0.05	0.10±0.05
Control group	0.12±0.03	0.16±0.02	0.09±0.05	0.16±0.04^*	0.10±0.03	0.14±0.09

Groups	CD3(%)	CD4(%)	CD8 (%)	CD4/CD8
Treatment
0	45.01±27.01	26.68±12.58	21.32±7.35	1.76±0.95
10th day	51.03±15.01^*	30.23±8.64^*	26.46±9.32^*	1.95±0.98^*
Control
0	46.65±10.35	27.23±6.48	20.89±6.81	1.56±0.87
10th day	50.26±14.42^#	30.64±9.25^#	24.68±7.28^#	1.89±0.92^#

Groups	Norepine- phrine (μg/min)	Blood lactate acid (mmol/L)	HR (beat/min)	Oxygenation index (mmHg)	RR (rate/min)
Treatment
0	28.3±11.7	3.31±3.61	121.5±20.45	100.5±42.31	35.21±9.43
5th day	10.6±8.7	2.14±1.65	94.25±18.73	151.3±32.37	27.24±6.74
10th day	8.9±8.2	1.35±1.52	92.14±16.26	187.4±55.16	24.12±8.75
Control
0	31±15.6	4.02±2.10	130.5±28.14	105.2±45.24	33.62±10.57
5th day	9.3±7.9	2.45±1.54	91.33±19.21	172.1±53.26	26.41±9.38
10th day	7.8±6.2	1.15±2.61	89.45±36.15	183.3±66.23	23.54±7.11

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