Hemofiltration increases IL-6 clearance in early systemic inflammatory response syndrome but does not alter IL-6 and TNF alpha plasma concentrations.
OBJECTIVE
To test the hypothesis that continuous hemofiltration increases interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF alpha) clearances and results in decreased cytokine plasma concentrations independent of renal function in patients with early SIRS.


METHODS
Prospective, controlled, randomized study.


METHODS
Intensive care units at a university hospital.


METHODS
28 consecutive patients who fulfilled the criteria of the systemic inflammatory response syndrome (SIRS).


METHODS
Patients with SIRS were randomly assigned to either a hemofiltration or a control group irrespective of renal function. In patients of the hemofiltration group an isovolemic hemofiltration was initiated directly after the diagnosis of SIRS and maintained for at least 48 h.


RESULTS
A significant (p < 0.001) increase in total IL-6 clearance (hemofiltrate + urine), but not in TNF alpha clearance, was observed with hemofiltration. However, the plasma concentrations of both cytokines remained unchanged. Hemodynamic variables did not change significantly.


CONCLUSIONS
Continuous hemofiltration increases IL-6 plasma clearance but not TNF alpha clearance. However, hemofiltration failed to decrease plasma concentrations of TNF alpha and IL-6 and, therefore, cannot be used effectively for cytokine elimination in SIRS. Accordingly, beneficial effects occasionally reported with hemofiltration are unlikely to be expected due to elimination of IL-6 or TNF alpha.
Sander
A
A
Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Germany. andreas.sander@uni-essen.de
Armbruster
W
W
Sander
B
B
Daul
A E
AE
Lange
R
R
Peters
J
J
D000328:Adult; D000368:Aged; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration; D006801:Humans; D015850:Interleukin-6 / Q000097:blood* / Q000652:urine; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha