[Opportunity for treatment of acute renal failure after cardiac vascular operation using continuous blood purification].
OBJECTIVE
To evaluate the effect and timing of continuous blood purification (CBP) in treatment of acute renal failure (ARF) following cardiac-vascular surgery.


METHODS
Twenty-five patients with ARF following cardiac-vascular surgery were divided into systematic inflammatory response syndrome (SIRS) Group (n = 13) and multiple organ dysfunction syndrome (MODS) Group (n = 12) according to the illness state prior to CBP and were divided into Group A (n = 5, with the APACHEIII score prior to CBP <or= 60), Group B (n = 9, with the APACHEIII score 61 - 90), and Group C (n = 11, with the APACHEIII score > 90). All of the 25 patients underwent continuous veno-venous hemofiltration (CVVH). Before and 24h after the CVVH APACHEIII score was calculated and [peripheral; blood samples were collected to detect the levels of blood urea nitrogen (BUN) and serum creatinine (Scr) and the plasma levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha).


RESULTS
The APACHEIII score, BUN, Scr, IL6, IL8, and TNFalpha 24 h after the CBP of the 25 patients were 61 +/- 15 mmol/L, (19 +/- 5) mmol/L, (312 +/- 87) micromol/L, (544 +/- 154) ng/L, (18 +/- 7) ng/L, and (43 +/- 15) ng/L respectively, all significantly lower than those before CBP (81 +/- 20, 26 +/- 5 mmol/L, 458 +/- 107 micromol/L, (842 +/- 132) ng/L, (25 +/- 8) ng/L, and (59 +/- 17) ng/L respectively, all P = 0.000). The survival rate of SIRS Group was 84.62%, significantly higher than that of MODS Group (41.67%, P < 0.05). The APACHEIII score, and the levels of BUN, Scr, IL6, IL8, and TNF-alpha of Group MODS were significantly higher than those of Group SIRS. The higher the level of Scr, IL6, IL8, and TNF-alpha and the APACHEIII score the lower the survival rate.


CONCLUSIONS
CBP has a positive effect on ARF following cardiac-vascular surgery. The APACHEIII score 60 to 90 reflects an opportunity to treat the ARF following cardiac-vascular surgery using CBP.
Mei
Yun-Qing
YQ
Heart-Lung-Blood Vessel Center of Tongji University, Institute of Heart-Lung-Blood Vessel Disease of Tongji University, Department of Thoracic Cardiovascular Surgery of Tongji Hospital of Tongji University, Shanghai 200065, China.
Li
Qiang
Q
Wang
Xi-Sheng
XS
Feng
Jing
J
Cai
Jian-Zhi
JZ
Sun
Yi-Feng
YF
Xie
Shi-Liang
SL
Li
Da-Wan
DW
Hu
Da-Yi
DY
D018806:APACHE; D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000628:therapy*; D001806:Blood Urea Nitrogen; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D009102:Multiple Organ Failure / Q000628:therapy; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000628:therapy*; D006435:Renal Dialysis / Q000379:methods*; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000628:therapy; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha