[Study the effects of high-volume hemofiltration and fluid resuscitation on removing blood lactic acid and pro-inflammatory cytokines in patients with refractory septic shock].
OBJECTIVE
To evaluate the effects of high-volume hemofiltration (HVHF) and fluid resuscitation on the levels of arterial lactate and inflammatory cytokines, the acute physiology and chronic health evaluation II (APACHE II) score, and sepsis-related organ failure assessment (SOFA) score in patients with refractory septic shock and multiple organ dysfunction syndrome (MODS).


METHODS
Eighty-nine patients with refractory septic shock and MODS undergoing HVHF, fluid resuscitation were included in the trial, and they were randomly divided into fluid resuscitation group (group A, 41 cases) and HVHF and fluid resuscitation group (group B, 48 cases). The changes in arterial lactate, lactate clearance rate, interleukin-6 (IL-6), procalcitonin (PCT), high sensitivity C-reactive protein (hs-CRP), APACHE II score and SOFA score in patients with refractory septic shock and MODS were determined before and after the treatment.


RESULTS
(1) The arterial lactate clearance rate after treatment in both groups was elevated gradually. The level of lactate clearance rate in group B at 6, 12, 24 hours [(18.8+/-10.3)%, (31.6+/-11.4)%, (39.2+/-16.4)%] were higher than that of group A, respectively [(10.7+/-7.5)%, (14.7+/-10.3)%, (16.5+/-10.2)%, P < 0.05 or P < 0.01]. (2) The levels of pro-inflammatory cytokine IL-6, PCT and hs-CRP were reduced gradually after treatment in both groups. After treatment, the serum concentration of IL-6, PCT and hs-CRP levels in group B were reduced significantly more than that in group A at 1 day and 3 days (P < 0.05 or P < 0.01). (3) The APACHE II and SOFA scores in both groups were reduced gradually on 3 days and 7 days after treatment, but the APACHE II and SOFA scores on 7 days in group B were lower compared with group A (P < 0.05 and P < 0.01).


CONCLUSIONS
HVHF and fluid resuscitation could reduce arterial lactate and cytokines contents, at the same time lower the APACHE II score and SOFA score in patients with refractory septic shock and MODS, thus it could improve the survival rate of MODS patients.
Wang
Chun-ting
CT
Department of Intensive Care Unit, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China.
Ren
Hong-sheng
HS
Jiang
Jin-jiao
JJ
Zhang
Ji-cheng
JC
Meng
Mei
M
Yu
Jie-bin
JB
Chu
Yu-feng
YF
Ding
Min
M
D018806:APACHE; D000328:Adult; D000368:Aged; D016207:Cytokines / Q000097:blood; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology / Q000628:therapy; D011379:Prognosis; D012151:Resuscitation; D012772:Shock, Septic / Q000097:blood / Q000150:complications / Q000628:therapy*; D055815:Young Adult
D016207:Cytokines; D019344:Lactic Acid