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Observational Study
. 2017 Feb 16;12(2):e0172039.
doi: 10.1371/journal.pone.0172039. eCollection 2017.

Organ dysfunction during continuous veno-venous high cut-off hemodialysis in patients with septic acute kidney injury: A prospective observational study

Gianluca Villa  1   2 , Cosimo Chelazzi  1   2 , Elena Morettini  1 , Lucia Zamidei  3 , Serafina Valente  4 , A Lucia Caldini  5 , Giovanni Zagli  1   2 , A Raffaele De Gaudio  1   2 , Stefano Romagnoli  1   2
Affiliations
Observational Study

Organ dysfunction during continuous veno-venous high cut-off hemodialysis in patients with septic acute kidney injury: A prospective observational study

Gianluca Villa et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: We have the following interests: Baxter has provided a grant to the Department of Health Science of the University of Florence for the cytokine analysis. GV received from Baxter support for travel expenses, hotel accommodations, and registration to meetings. CC received honoraria for lectures by Orion Pharma; a grant for consultancy by Astellas; support for meetings (travel, hotel accommodations and/or registration) by BBraun, Astellas, MSD, Pfizer, Pall International, Baxter, Orion Pharma. ARDG received research grants from MSD Italia, Baxter, Pall international. SR received from Baxter, Orion Pharma, and Vygon honoraria for lectures, from ICU Medical, MSD and Medtronic grants for consultancy, from Baxter, BBraun, Pall International, and Vygon support for travel expenses, hotel accommodations, and registration to meetings. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Inclusion and exclusion criteria.
Fig 2
Fig 2. SOFA score.
Mean and SD of SOFA scores cumulatively observed for the entire population at the baseline, and then at 6, 12, 24 and 48 hrs after HCO-CVVHD initiation; and at 24 and 48 hrs after HCO-CVVHD discontinuation (Panel A). In Panel B, SOFA scores are shown for each subgroup (Survivors and non-Survivors). * Value statistically different to the baseline through statistical test for pairs data. † Value statistically different between groups through statistical test for unpaired data.
Fig 3
Fig 3. Circulating levels of inflammatory mediators.
Concentrations of mediators are expressed in a logarithmic scale.
See this image and copyright information in PMC

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