title: Immunomodulatory effect of continuous venovenous hemofiltration during sepsis: preliminary data.
abstract: BACKGROUND
  Severe sepsis and septic shock are the primary causes of multiple organ dysfunction syndrome (MODS), which is the most frequent cause of death in intensive care unit patients. Many pro- and anti-inflammatory mediators, such as interleukin-6 (IL-6), play a strategic role in septic syndrome. Continuous renal replacement therapy (CRRT) removes in a nonselective way pro- and anti-inflammatory mediators.
  
  
  OBJECTIVE
  To investigate the effects of continuous venovenous hemofiltration (CVVH) as an immunomodulatory treatment of sepsis in a prospective clinical study.
  
  
  METHODS
  High flux hemofiltration (Qf = 60 ml/Kg/hr) was performed for 72 hr in thirteen critically ill patients suffering from severe sepsis or septic shock with acute renal failure (ARF). IL-6 gene expression was measured by real-time PCR analysis on RNA extracted from peripheral blood mononuclear cell before beginning of treatment (T0) and after 12, 24, 48, and 72 hours (T1-4).
  
  
  RESULTS
  Real-time PCR analysis demonstrated in twelve patients IL-6 mRNA reduction after 12 hours of treatment and a progressive increase after 24, 48, and 72 hours.
  
  
  CONCLUSIONS
  We suggest that an immunomodulatory effect might exist during CVVH performed in critically ill patients with severe sepsis and septic shock. Our data show that the transcriptional activity of IL-6 increases during CVVH.
authors: Medical Intensive Care Unit, Department of Surgical and Anesthesiological Sciences, University Federico II of Naples, 80129 Naples, Italy.
authors: Giuseppe
authors: G
authors: Servillo
authors: Maria
authors: M
authors: Vargas
authors: Antonio
authors: A
authors: Pastore
authors: Alfredo
authors: A
authors: Procino
authors: Michele
authors: M
authors: Iannuzzi
authors: Alfredo
authors: A
authors: Capuano
authors: Andrea
authors: A
authors: Memoli
authors: Eleonora
authors: E
authors: Riccio
authors: Bruno
authors: B
authors: Memoli
mesh_terms: D058186:Acute Kidney Injury / Q000276:immunology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D056747:Immunomodulation / Q000276:immunology*; D015850:Interleukin-6 / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D018805:Sepsis / Q000276:immunology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D015850:Interleukin-6
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