title: Evaluation of plasma exchange and continuous veno-venous hemofiltration for the treatment of severe avian influenza A (H7N9): a cohort study.
abstract: Avian influenza A (H7N9) is a severe disease with high mortality. Hypercytokinemia is thought to play an important role in the pathogenesis. This study was to investigate the efficiency of plasma exchange (PE) + continuous veno-venous hemofiltration (CVVH) on the removal of inflammatory mediators and their benefits in the management of fluid overload and metabolic disturbance. In total, 40 H7N9-infected patients were admitted to our hospital. Sixteen critically ill H7N9-infected patients received combination of PE and CVVH. Data from these 16 patients were collected and analyzed. The effects of PE + CVVH on plasma cytokine/chemokine levels and clinical outcomes were examined. H7N9-infected patients had increased plasma levels compared to healthy controls. After 3 h of PE + CVVH treatment, the cytokine/chemokine levels descended remarkably to lower levels and were maintained thereafter. PE + CVVH also benefited the management of fluid, cardiovascular dysfunction and metabolic disturbance. Of the 16 critically ill patients who received PE + CVVH, 10 patients survived. PE + CVVH decreased the plasma cytokine/chemokine levels significantly. PE + CVVH were also beneficial to the management of severe avian influenza A (H7N9).
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Liu
authors.forename: Yimin
authors.initials: Y
authors.lastname: Zhang
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Xu
authors.forename: Weibo
authors.initials: W
authors.lastname: Du
authors.forename: Kunkai
authors.initials: K
authors.lastname: Su
authors.forename: Chunxia
authors.initials: C
authors.lastname: Zhu
authors.forename: Yuemei
authors.initials: Y
authors.lastname: Chen
authors.forename: Shuiying
authors.initials: S
authors.lastname: Lei
authors.forename: Shufa
authors.initials: S
authors.lastname: Zheng
authors.forename: Jianwen
authors.initials: J
authors.lastname: Jiang
authors.forename: Shigui
authors.initials: S
authors.lastname: Yang
authors.forename: Jing
authors.initials: J
authors.lastname: Guo
authors.forename: Li
authors.initials: L
authors.lastname: Shao
authors.forename: Qian
authors.initials: Q
authors.lastname: Yang
authors.forename: Jiajia
authors.initials: J
authors.lastname: Chen
authors.forename: Lanjuan
authors.initials: L
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D064766:Influenza A Virus, H7N9 Subtype; D007251:Influenza, Human / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Avian influenza A; Cytokine; H7N9; Hemofiltration; Plasma exchange