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

Abstract

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.