Organ dysfunction during continuous veno-venous high cut-off hemodialysis in patients with septic acute kidney injury: A prospective observational study.

Autor: Villa G; Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.; Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Chelazzi C; Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.; Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Morettini E; Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy., Zamidei L; Anesthesia and Intensive Care Unit, Ospedale Santo Stefano, Prato, Italy., Valente S; Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Caldini AL; Clinical Chemistry Laboratory, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Zagli G; Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.; Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., De Gaudio AR; Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.; Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Romagnoli S; Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.; Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2017 Feb 16; Vol. 12 (2), pp. e0172039. Date of Electronic Publication: 2017 Feb 16 (Print Publication: 2017).
DOI: 10.1371/journal.pone.0172039
Abstrakt: Background: Continuous veno-venous hemodialysis with high cut-off membranes (HCO-CVVHD) removes inflammatory mediators involved in organ dysfunction during sepsis. The aim of the present study was to assess the variations in SOFA score and identify early predictors of short-term mortality in a cohort of patients with septic shock, treated with HCO-CVVHD for acute kidney injury (AKI).
Methods: An observational prospective multicenter cohort study was conducted in four mixed medical-surgical ICUs. Thirty-eight patients with septic shock and AKI (KDIGO stage≥1) treated with HCO-CVVHD have been included in this study. Patients were divided into Survivors and non-Survivors according to mortality observed at 72nd hr of treatment. The variation of SOFA scores and clinical/biochemical parameters were described over time for the entire population and specifically for Survivors and non-Survivors. Similarly, circulating inflammatory mediators (as IL-6, TNF-a and IL-10) were described over time. A logistic regression analysis was used to identify the baseline clinical and biochemical parameters associated with 72 hrs-ICU mortality.
Results: Overall, the mean SOFA score was 12±3 at baseline, 10.9±3 at 6hrs, 9.8±3 at 12hrs, 8.9±3.3 at 24 hrs, and 8±3.5 at 48 hrs after HCO-CVVHD initiation; and 6.5±2.7 at 24 hrs and 6.6±3 at 48 hrs after HCO-CVVHD discontinuation. In the multivariate regression analysis, baseline serum lactate levels and AKI stage independently correlated with short-term mortality during HCO-CVVHD. A significant reduction was observed in circulating levels of TNFα and IL-6 among Survivors.
Conclusions: SOFA score significantly decreased early after initiation of HCO-CVVHD in patients with septic AKI. Baseline lactate levels and the AKI stage resulted to be associated to 72 hrs-ICU-mortality.
Databáze: MEDLINE
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