Blood purification with continuous veno-venous hemofiltration in patients with sepsis or ARDS: a systematic review and meta-analysis

Putzu, Alessandro; Fang, Mingxing; Berto, Martina Boscolo; Belletti, Alessandro; Cabrini, Luca; Cassina, Tiziano; Landoni, Giovanni

doi:10.23736/s0375-9393.17.11946-2

Cited by 25 publications

(13 citation statements)

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“…Second, CVVH is not a standardized technique. Hence, the settings (e.g., CVVH doses) and system used in the present study could result in different results from other studies 12,18 ; in addition, we did not have intermittent renal replacement therapy or standard CVVH as a control group and thus have not provided any additional effects of high‐volume CVVH over other models of renal replacement therapy. Third, the differences in subgroups were not assessed on the basis of sex and septic shock.…”

Section: Discussionmentioning

confidence: 82%

“…It was not surprising that the 28‐day mortality of patients with sepsis failed to be significantly decreased by high‐dose CVVH treatment in spite of the significantly decreased SOFA scores, which is inconsistent with the meta‐analysis published by Putzu et al, stating that low‐quality evidence indicates the correlation between CVVH and the significant reduction in mortality in patients with severe sepsis 3,12 . There are several potential explanations for this phenomenon.…”

Section: Discussionmentioning

confidence: 93%

“…The direct removal of inflammatory mediators from circulation appears to be intuitively attractive, since this could efficiently interrupt the inflammatory cascade, affect the differentiation of CD4 + T subtypes, and attenuate inflammation. Continuous blood purification is a pivotal treatment strategy for renal failure in the intensive care setting 3,10–12 . Notably, recent studies revealed that in addition to the removal of waste products, other molecules, such as inflammatory mediators/cytokines, were also the targets of removal in continuous blood purification, especially high‐dose (namely high‐volume) hemofiltration, for patients with sepsis 10,11,13–20 .…”

Section: Introductionmentioning

confidence: 99%

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Early high‐dose continuous veno‐venous hemofiltration alleviates the alterations of CD4+ T lymphocyte subsets in septic patients combined with acute kidney injury

et al. 2022

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BackgroundThis study aims to observe the changes in CD4 + T lymphocyte subsets in septic patients combined with acute kidney injury and the effect of early high-dose CVVH on CD4 + T lymphocyte subsets. MethodsEnrolled septic patients combined with acute kidney injury were randomly divided into CVVH (n = 50) and conventional treatment (non-CVVH, n = 53) groups. Healthy volunteers (n = 21) were enrolled. CVVH was initiated within 12 h of intensive care unit (ICU) admission with the doses of 35 ~ 60 mL/kg/h and maintained for at least 72 h. Th1, Th2, Th17 and T reg were measured by ow cytometry on days 1, 3 and 7 of ICU admission. Sequential organ failure assessment (SOFA) scores were calculated. ResultsTh1 percentages and Th1/Th2 ratios were lower, and Th2, Th17 and T reg percentages and Th17/T reg ratios were higher in patients with sepsis, when compared to healthy volunteers (all P < 0.05). Early highdose CVVH treatment signi cantly increased Th1 percentages and Th1/Th2 ratios, and signi cantly decreased Th2, Th17 and T reg percentages and Th17/T reg ratios, when compared to non-CVVH treatment (all P < 0.05). Th1 percentages and Th1/Th2 ratios were negatively correlated with SOFA scores, while Th2, Th17 and T reg percentages and Th17/T reg ratios were positively correlated with SOFA scores (all P < 0.05). Patients with sepsis in the CVVH group had signi cantly lower SOFA scores on day 7 of ICU admission and a shorter ICU stay when compared to those in the non-CVVH group (P < 0.05). However, the difference in 28-day mortality was not signi cant between the CVVH and non-CVVH groups (22.0% vs. 37.7%, P = 0.104). ConclusionSeptic patients combined with acute kidney injury exhibit the different alterations of CD4 + T lymphocyte subsets. Early high-dose CVVH treatment could alleviate the alterations, which may be one of factors associated with the improvement of sepsis severity, but do not signi cantly decrease the 28-day mortality.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Early high‐dose continuous veno‐venous hemofiltration alleviates the alterations of CD4+ T lymphocyte subsets in septic patients combined with acute kidney injury

et al. 2022

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“…However, our study shows that the initial creatinine value has little signi cance in evaluating prognosis. Thus, the mature and early application of the CRRT technology could be the reason for the declining renal function indicator values in assessing the prognosis of sepsis patients [31].…”

Section: Discussionmentioning

confidence: 99%

Establishment and Verification On A Death Risk Model of Sepsis Patients Within 30 Days

Wang

Chen

Ouyang

2021

Preprint

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Background/Objective: To establish and validate an individualized nomogram to predict the probability of death within 30 days in patients with sepsis would help clinical physicians to make correct decision. Methods We collected data of 1,205 patients with sepsis. These included 16 indexes like age and blood, randomly assigned to the modeling and verification groups. In the modeling group, the independent risk factors related to death within 30 days were analyzed. Besides, a nomogram was established to draw the receiver-operating characteristic (ROC) curve of the subjects. Subsequently, the discriminant ability of the model was evaluated by the area under the ROC curve (AUC). Then, a calibration chart and Hosmer-Lemeshow test were employed to evaluate the calibration degree of the model, and the Decline Curve Analysis (DCA) test was used to evaluate the clinical effect of the model. Results The different independent risk factors related to the death of sepsis patients within 30 days included pro-brain natriuretic peptide (pro.bnp), albumin, lactic acid (lac), oxygenation index, mean arterial pressure (map), and hematocrit (hct). The AUC of the modeling and verification groups were 0.815 and 0.806, respectively. Moreover, the P-values of the Hosmer-Lemeshow test in the two groups were 0.391 and 0.100, respectively, and the DCA curves of the two groups were both above the two extreme curves. Conclusion Our model presents good significance for predicting the death of sepsis patients within 30 days. Therefore, there is a need to implement this model in clinical practice, as prompt prediction could help tailor treatment regimens and enhance survival outcomes.

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“…Nevertheless, the latest international guidelines for the management of sepsis and septic shock published in 2016 make no supportive recommendation regarding the use of CVVH due to insufficient strong evidence [ 4 ]. Data from seven clinical trials have shown that CVVH treatment reduces short-term and long-term mortality in septic patients [ 5 ]. However, a meta-analysis of only three clinical trials reported no significant differences in survival between septic patients on conservative treatment and those on treatment combined with high-volume haemofiltration [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Glutathione Reductase Is Associated with the Clinical Outcome of Septic Shock in the Patients Treated Using Continuous Veno-Venous Haemofiltration

et al. 2021

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Background and objectives: At present, there is insufficient evidence to support the use of continuous veno-venous haemofiltration (CVVH) in the early treatment of septic shock. This study focuses on the association between survival and different parameters of oxidative stress (RedOx). Thereby, we evaluated whether RedOx markers are associated with the outcome of septic shock in patients under early-initiated CVVH treatment. Materials and Methods: We conducted a prospective observational study of 65 patients with septic shock who started CVVH within 12 h after hospital admission. Blood samples were taken from each patient prior to the start of CVVH. The following RedOx markers were measured: glutathione peroxidase, glutathione reductase (GR), total antioxidant capacity, superoxide dismutase, nitric oxide, malondialdehyde and 4-hydroxynonenal. The odds ratio (OR) was calculated using binary logistic regression and stepwise multivariable regression. Results: The 65 patients had a median age of 66 years and 39 were male. Based on the outcome, the patients were divided into two groups—non-survivors (n = 29) and survivors (n = 36)—and the levels of RedOx markers were compared between them. Of all the markers, only higher GR activity was found to be significantly associated with the fatal outcome; 100.3 U/L versus 60.5 U/L, OR = 1.027 (95% CI, 1.010–1.044). Following adjustment for the sequential organ failure assessment score and other parameters, GR activity still presented a significant association with the fatal outcome, OR = 1.020 (95% CI, 1.002–1.038). Conclusions: GR activity is associated with in-hospital fatal outcomes among septic shock patients under early-initiated CVVH treatment. Septic shock patients who have a lower GR activity at hospital admission may have a favourable outcome of the early initiation of CVVH.

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Blood purification with continuous veno-venous hemofiltration in patients with sepsis or ARDS: a systematic review and meta-analysis

Cited by 25 publications

References 0 publications

Early high‐dose continuous veno‐venous hemofiltration alleviates the alterations of CD4+ T lymphocyte subsets in septic patients combined with acute kidney injury

Early high‐dose continuous veno‐venous hemofiltration alleviates the alterations of CD4+ T lymphocyte subsets in septic patients combined with acute kidney injury

Establishment and Verification On A Death Risk Model of Sepsis Patients Within 30 Days

Glutathione Reductase Is Associated with the Clinical Outcome of Septic Shock in the Patients Treated Using Continuous Veno-Venous Haemofiltration

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