title: Organ dysfunction during continuous veno-venous high cut-off hemodialysis in patients with septic acute kidney injury: A prospective observational study.
abstract: BACKGROUND
  Continuous veno-venous hemodialysis with high cut-off membranes (HCO-CVVHD) removes inflammatory mediators involved in organ dysfunction during sepsis. The aim of the present study was to assess the variations in SOFA score and identify early predictors of short-term mortality in a cohort of patients with septic shock, treated with HCO-CVVHD for acute kidney injury (AKI).
  
  
  METHODS
  An observational prospective multicenter cohort study was conducted in four mixed medical-surgical ICUs. Thirty-eight patients with septic shock and AKI (KDIGO stage≥1) treated with HCO-CVVHD have been included in this study. Patients were divided into Survivors and non-Survivors according to mortality observed at 72nd hr of treatment. The variation of SOFA scores and clinical/biochemical parameters were described over time for the entire population and specifically for Survivors and non-Survivors. Similarly, circulating inflammatory mediators (as IL-6, TNF-a and IL-10) were described over time. A logistic regression analysis was used to identify the baseline clinical and biochemical parameters associated with 72 hrs-ICU mortality.
  
  
  RESULTS
  Overall, the mean SOFA score was 12±3 at baseline, 10.9±3 at 6hrs, 9.8±3 at 12hrs, 8.9±3.3 at 24 hrs, and 8±3.5 at 48 hrs after HCO-CVVHD initiation; and 6.5±2.7 at 24 hrs and 6.6±3 at 48 hrs after HCO-CVVHD discontinuation. In the multivariate regression analysis, baseline serum lactate levels and AKI stage independently correlated with short-term mortality during HCO-CVVHD. A significant reduction was observed in circulating levels of TNFα and IL-6 among Survivors.
  
  
  CONCLUSIONS
  SOFA score significantly decreased early after initiation of HCO-CVVHD in patients with septic AKI. Baseline lactate levels and the AKI stage resulted to be associated to 72 hrs-ICU-mortality.
authors.affiliation: Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.|Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Gianluca
authors.identifier: http://orcid.org/0000-0003-4274-3593
authors.initials: G
authors.lastname: Villa
authors.affiliation: Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.|Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Chelazzi
authors.affiliation: Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Morettini
authors.affiliation: Anesthesia and Intensive Care Unit, Ospedale Santo Stefano, Prato, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Zamidei
authors.affiliation: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.affiliation: Clinical Chemistry Laboratory, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: A Lucia
authors.initials: AL
authors.lastname: Caldini
authors.affiliation: Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.|Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zagli
authors.affiliation: Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.|Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: A Raffaele
authors.initials: AR
authors.lastname: De Gaudio
authors.affiliation: Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.|Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Romagnoli
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D012772:Shock, Septic / Q000150:complications* / Q000628:therapy; D055815:Young Adult