Cytokine Patterns in Patients Who Undergo Hemofiltration for Treatment of Multiple Organ Failure

Abstract

The excessive uncontrolled activation of inflammatory cells and mediators after trauma or major surgery plays a key role in the development of adult respiratory distress syndrome and multiple organ system failure (MOSF). In the past elevated cytokine levels were shown to influence the outcome of these patients adversely. There are diverging results regarding the removal of circulating cytokines by various methods of hemopurification for clinical improvement of MOSF. Seven patients after trauma or major surgery underwent continuous venovenous hemofiltration (CVVH) for the treatment of severe organ failure of the heart and lungs (Murray score 2.74) but not for renal or liver failure. The cytokine levels were measured at the beginning and 15, 60, 120, and 240 minutes after initiation of CVVH (measure points MP1-5). Clinical improvement during the treatment was monitored, and correlation with cytokine levels was evaluated. Arterially measured tumor necrosis factor alpha rose from 11.14 ng/ml to 17.86 ng/m1 (p < 0.05). Arterial interleukin-6 (IL-6) levels significantly decreased during CVVH from 1284.7 ng/m1 to 557.9 ng/m1; IL-8 levels simultaneously decreased from an initial peak of up to 154.4 ng/m1 at MP3 to 97.3 ng/m1 at MP5. The drop in serum IL-6 and IL-8 levels closely correlated with clinical improvement. After 2 hours of CVVH the hemodynamic situation improved significantly, as revealed by a decrease in catecholamine expenditure, an increase in arterial pressure, and a decrease in pulmonary artery pressure. Moreover, 2 hours after the initiation of CVVH the oxygenation index rose significantly and correlated well with the drop in shunt fraction. The Murray score significantly fell to 1.86. The removal of IL-6 and IL-8 by CVVH after initial stimulation correlates with clinical improvement, which was demonstrated by significantly improved oxygenation and hemodynamics from 2 hours after the initiation of CVVH onward. The elimination of cytokines and several mediators by CVVH may contribute to the cardiopulmonary improvement of critically ill patients. In comparison with the clinical control group (n = 7), which was comparable in terms of MOSF, no intervention led to a similar improvement in cardiorespiratory failure, and overall two of these patients died. Moreover, patients of the control group experienced a significant longer stay at in the intensive care unit.

High volume continuous venovenous haemofiltration (HV‐CVVH) in an equine endotoxaemic shock model

“…Other clinical studies showed contradictory results on the removal of TNF, although sieving coefficients ranged from 0-52%, plasma TNF levels did not decrease in many clinical studies (Hoffmann and Faist 2001). Koperna et al (1998) even showed an increase of TNF levels during haemofiltration. Moreover, the use of different membranes and haemofiltration devices may result in different TNF elimination rates.…”

Improvement of Oxygenation in Severe Acute Respiratory Distress Syndrome With High-Volume Continuous Veno-venous Hemofiltration

“…Indeed, several studies have shown that CRRT can remove serum systemic inflammatory mediators that contribute to ARDS pathogenesis by convection and absorption. 6 , 16 - 19 …”

Changing the terminology from kidney replacement therapy to kidney support therapy

“…Although plasma levels of these cytokines remained stable, the septic patients' cardiac output and stroke volume normalized just 1 day after starting treatment 3 . Other studies have similar findings, suggesting that cytokine removal by KRT is not clinically significant and that resulting cardiovascular benefits of KRT are not related to cytokine clearance 14–16 . Rather, improvements may be due to the elimination of excess fluid and the resulting hemodynamic stability.…”