Effect of high volume hemofiltration combined with continuous plasma filtration absorption on inflammatory response and respiratory function in patients with sepsis-associated acute respiratory distress syndrome

doi:10.3877/cma.j.issn.1674-0785.2024.12.004

Abstract

Abstract:

Objective

To explore the effect of high volume hemofltration (HVHF) combined with continuous plasma filtration absorption (CPFA) on inflammatory response and respiratory function in patients with sepsis-associated acute respiratory distress syndrome (ARDS).

Methods

Sixty patients with sepsis complicated by ARDS, treated in the Department of Critical Care Medicine of the Third Hospital of Hebei Medical University, were randomly divided into an HVHF group and an HVHF+CPFA group, which received standard HVHF treatment and HVHF combined with HA380 hemoperfusion, respectively. The general patient data, including age, sex, sequential organ failure assessment (SOFA) score, acute physiology and chronic health status evaluation (APACHE Ⅱ) score, vital signs (such as heart rate [HR] and respiratory rate [RR]),procalcitonin (PCT), lactic acid (Lac), and total bilirubin (TBil), were compared between the two groups.The main study outcomes [white blood cell count (WBC), serum interleukin 6 (IL-6), carbon dioxide partial pressure (PCO₂), oxygenation index (PaO₂/FiO₂), aspartate aminotransferase (AST), alanine aminotransferase(ALT), and mechanical power (MP)] and secondary study outcomes [mean arterial pressure (MAP), central venous pressure (CVP), platelet count (PLT), prognostic indicators (ICU mortality and ICU stay)] were compared between the two groups before and 12 h and 24 h after treatment.

Results

A total of 60 patients were enrolled, with 30 in the HVHF group and 30 in the HVHF+CHVHF group, most of whom were male(70%). There were no statistically significant differences between the two groups in terms of gender, age,pre-treatment SOFA score, HR, MAP, RR, MP, WBC, PCT, Lac, TBiL, IL-6, PLT, AST, ALT, CVP, PCO₂,and PaO₂/FiO₂ (P＞0.05). Compared with the HVHF group, the serum IL-6 levels in the HVHF+ CHVHF group showed a downward trend at 24 and 48 hours after treatment, as well as a decreasing trend in PLT and MP at 48 hours after treatment, with statistically significant differences between the two groups (P＜0.05).No statistically significant differences were observed between the two groups in other parameters (P＞0.05).Generalized estimating equation (GEE) analysis showed that treatment modality, APACHE II score, WBC,and time were factors influencing MP, and treatment modality and time were factors influencing IL-6 after controlling for other factors (gender, age, pre-treatment SOFA score, HR, MAP, RR, PCT, Lac, TBiL, PLT,AST, ALT, CVP, PCO₂, and PaO₂/FiO₂).

Conclusion

HVHF combined with CPFA is an effective means of treating patients with sepsis complicated by ARDS, as it effectively clears IL-6 and reduces MP.

Key words: Sepsis, Acute respiratory distress syndrome, Hemoperfusion, Oxygenation index, Mechanical power

Yaoyao Tang, Ying Guo, Hongxiao Qin, Jingjing Yu, Yixuan Zhang, Mingxing Fang, Wenli Meng. Effect of high volume hemofiltration combined with continuous plasma filtration absorption on inflammatory response and respiratory function in patients with sepsis-associated acute respiratory distress syndrome[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(12): 1097-1103.

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Figures/Tables 4

指标	HVHF 组（30 例）	HVHF+CHVHF 组（30 例）	检验值	P 值
性别[ 例（%）]			χ ²=1.025	0.573
男性	22（73.3%）	20（66.7%）
女性	8（26.7%）	10（33.3%）
年龄[ 岁，M（QL，QU）， $\overset{ˉ}{x}$ ±s]	57.67±17.16	53.00±13.47	t=1.314	0.246
SOFA 评分[ 分，M（QL，QU）， $\overset{ˉ}{x}$ ±s]	9.00[8.00，12.00]	8.00[7.00，10.00]	Z=2.382	0.066
APACH Ⅱ评分[ 分，M（QL，QU）， $\overset{ˉ}{x}$ ±s]	22.87±6.74	26.43±7.07	t=3.002	0.056
HR[ 次/ 分， $\overset{ˉ}{x}$ ±s]	98.50±21.24	98.23±17.50	t=0.058	0.958
RR[ 次/ 分， $\overset{ˉ}{x}$ ±s]	21.30±7.21	24.21±5.52	t=0.036	0.974
MAP[mmHg， $\overset{ˉ}{x}$ ±s]	86.57±16.27	79.43±14.35	t=0.059	0.953
WBC[×109/L，M（QL，QU）]	8.80[6.71，15.91]	15.11[6.90，26.38]	Z=1.429	0.101
PCT[μg/L，M（QL，QU）]	15.00[3.51，32.57]	19.05[9.25，48.59]	Z=1.634	0.153
Lac[mmol/L，M（QL，QU）]	1.65[0.95，2.55]	1.50[1.10，2.43]	Z=0.462	0.722
IL-6[pg/ml，M（QL，QU）]	87.48[91.14，852.65]	221.99[36.73，1890.54]	Z=0.165	0.918
PLT[×10⁹/L，M（QL，QU）]	64.50[32.00，114.22]	58.00[29.00，117.00]	Z=0.247	0.842
AST[U/L，M（QL，QU）]	75.50[35.00，468.75]	108.00[62.50，194.75]	Z=0.477	0.657
ALT[U/L，M（QL，QU）]	52.50[21.75，377.75]	106.00[31.25，280.25]	Z=0.369	0.784
TBiL[μmol/L，M（QL，QU）]	54.93[15.00，66.83]	55.20[25.73，89.96]	Z=2.484	0.056
CVP[mmHg， $\overset{ˉ}{x}$ ±s]	10.60±3.64	9.87±3.13	t=0.878	0.406
PCO₂[cmH₂O， $\overset{ˉ}{x}$ ±s]	45.09±6.56	46.42±21.47	t=2.320	0.080
FiO₂/PO₂[cmH₂O，M（QL，QU）]	187.50[152.00，213.00]	166.50[129.80，210.00]	Z=1.325	0.191
MP[J/min，M（QL，QU）]	12.91[11.80，15.35]	15.90[11.77，17.89]	Z=1.368	0.169

指标	HVHF 组（30 例）	HVHF+CHVHF 组（30 例）	检验值	P 值
性别[ 例（%）]			χ ²=1.025	0.573
男性	22（73.3%）	20（66.7%）
女性	8（26.7%）	10（33.3%）
年龄[ 岁，M（QL，QU）， $\overset{ˉ}{x}$ ±s]	57.67±17.16	53.00±13.47	t=1.314	0.246
SOFA 评分[ 分，M（QL，QU）， $\overset{ˉ}{x}$ ±s]	9.00[8.00，12.00]	8.00[7.00，10.00]	Z=2.382	0.066
APACH Ⅱ评分[ 分，M（QL，QU）， $\overset{ˉ}{x}$ ±s]	22.87±6.74	26.43±7.07	t=3.002	0.056
HR[ 次/ 分， $\overset{ˉ}{x}$ ±s]	98.50±21.24	98.23±17.50	t=0.058	0.958
RR[ 次/ 分， $\overset{ˉ}{x}$ ±s]	21.30±7.21	24.21±5.52	t=0.036	0.974
MAP[mmHg， $\overset{ˉ}{x}$ ±s]	86.57±16.27	79.43±14.35	t=0.059	0.953
WBC[×109/L，M（QL，QU）]	8.80[6.71，15.91]	15.11[6.90，26.38]	Z=1.429	0.101
PCT[μg/L，M（QL，QU）]	15.00[3.51，32.57]	19.05[9.25，48.59]	Z=1.634	0.153
Lac[mmol/L，M（QL，QU）]	1.65[0.95，2.55]	1.50[1.10，2.43]	Z=0.462	0.722
IL-6[pg/ml，M（QL，QU）]	87.48[91.14，852.65]	221.99[36.73，1890.54]	Z=0.165	0.918
PLT[×10⁹/L，M（QL，QU）]	64.50[32.00，114.22]	58.00[29.00，117.00]	Z=0.247	0.842
AST[U/L，M（QL，QU）]	75.50[35.00，468.75]	108.00[62.50，194.75]	Z=0.477	0.657
ALT[U/L，M（QL，QU）]	52.50[21.75，377.75]	106.00[31.25，280.25]	Z=0.369	0.784
TBiL[μmol/L，M（QL，QU）]	54.93[15.00，66.83]	55.20[25.73，89.96]	Z=2.484	0.056
CVP[mmHg， $\overset{ˉ}{x}$ ±s]	10.60±3.64	9.87±3.13	t=0.878	0.406
PCO₂[cmH₂O， $\overset{ˉ}{x}$ ±s]	45.09±6.56	46.42±21.47	t=2.320	0.080
FiO₂/PO₂[cmH₂O，M（QL，QU）]	187.50[152.00，213.00]	166.50[129.80，210.00]	Z=1.325	0.191
MP[J/min，M（QL，QU）]	12.91[11.80，15.35]	15.90[11.77，17.89]	Z=1.368	0.169

组别	HVHF 组（30 例）	HVHF+CHVHF 组（30 例）
时间	基线	24 h	48 h	基线	24 h	48 h
MAP[mmHg， $\overset{ˉ}{x}$ ±s]	86.57±16.27	86.13±16.77	81.17±16.84	79.43±14.35	81.43±11.98	85.30±16.25
WBC[×10⁹/L，M（QL，QU）]	8.80[6.71，15.91]	11.12[7.77，16.53]	13.13[7.47，18.37]	15.11[6.90，26.38]	14.85[6.90，26.84]	15.87[9.63，26.32]
PCT[μg/L，M（QL，QU）]	15.00[3.51，32.57]	12.30[3.63，29.51]	12.47[6.41，22.63]	19.05[9.25，48.59]	14.56[5.30，36.23]	11.09[3.01，26.51]
IL-6[pg/mL，M（QL，QU）]	87.48[91.14，852.65]	338.89[172.23，779.50]	194.47[102.98，745.00]	221.99[36.73，1890.54]	118.89[44.25，359.08]a	110.14[39.78，351.46]a
PLT[×10⁹/L，M（QL，QU）]	64.50[32.00，114.22]	66.50[49.75，105.50]	50.00[35.00，118.00]	58.00[29.00，117.00]	40.50[18.50，106.75]	35.50[14.25，73.50]a
AST[U/L，M（QL，QU）]	75.50[35.00，468.75]	91.00[47.75，639.50]	89.00[39.50，440.00]	108.00[62.50，194.75]	93.00[52.00，275.50]	62.50[26.00，156.00]
ALT[U/L，M（QL，QU）]	52.50[21.75，377.75]	66.50[26.00，726.00]	112.00[25.00，523.00]	106.00[31.25，280.25]	4.08[1.85，87.25]	3.96[2.15，88.75]
PCO₂[cmH₂O， $\overset{ˉ}{x}$ ±s]	35.09±6.56	47.86±52.40	38.64±6.23	46.42±21.47	177.62±752.37	39.86±6.44
FiO₂/PO₂[cmH₂O，M（QL，QU）， $\overset{ˉ}{x}$ ±s]	187.50[152.00，213.00]	205.00[163.25，242.75]	200.40±55.92	166.50[129.80，210.00]	200.65[172.16，229.38]	194.88±49.24
CVP[mmHg， $\overset{ˉ}{x}$ ±s]	10.60±3.64	10.23±3.94	11.10±4.10	9.87±3.13	9.90±3.85	9.97±3.70
MP[J/min，M（QL，QU）]	12.91[11.80，15.35]	11.41[10.42，13.88]	11.88[10.34，14.17]	15.90[11.77，17.89]	12.90[10.45，14.13]	10.29[8.69，12.45]^a

组别	HVHF 组（30 例）	HVHF+CHVHF 组（30 例）
时间	基线	24 h	48 h	基线	24 h	48 h
MAP[mmHg， $\overset{ˉ}{x}$ ±s]	86.57±16.27	86.13±16.77	81.17±16.84	79.43±14.35	81.43±11.98	85.30±16.25
WBC[×10⁹/L，M（QL，QU）]	8.80[6.71，15.91]	11.12[7.77，16.53]	13.13[7.47，18.37]	15.11[6.90，26.38]	14.85[6.90，26.84]	15.87[9.63，26.32]
PCT[μg/L，M（QL，QU）]	15.00[3.51，32.57]	12.30[3.63，29.51]	12.47[6.41，22.63]	19.05[9.25，48.59]	14.56[5.30，36.23]	11.09[3.01，26.51]
IL-6[pg/mL，M（QL，QU）]	87.48[91.14，852.65]	338.89[172.23，779.50]	194.47[102.98，745.00]	221.99[36.73，1890.54]	118.89[44.25，359.08]a	110.14[39.78，351.46]a
PLT[×10⁹/L，M（QL，QU）]	64.50[32.00，114.22]	66.50[49.75，105.50]	50.00[35.00，118.00]	58.00[29.00，117.00]	40.50[18.50，106.75]	35.50[14.25，73.50]a
AST[U/L，M（QL，QU）]	75.50[35.00，468.75]	91.00[47.75，639.50]	89.00[39.50，440.00]	108.00[62.50，194.75]	93.00[52.00，275.50]	62.50[26.00，156.00]
ALT[U/L，M（QL，QU）]	52.50[21.75，377.75]	66.50[26.00，726.00]	112.00[25.00，523.00]	106.00[31.25，280.25]	4.08[1.85，87.25]	3.96[2.15，88.75]
PCO₂[cmH₂O， $\overset{ˉ}{x}$ ±s]	35.09±6.56	47.86±52.40	38.64±6.23	46.42±21.47	177.62±752.37	39.86±6.44
FiO₂/PO₂[cmH₂O，M（QL，QU）， $\overset{ˉ}{x}$ ±s]	187.50[152.00，213.00]	205.00[163.25，242.75]	200.40±55.92	166.50[129.80，210.00]	200.65[172.16，229.38]	194.88±49.24
CVP[mmHg， $\overset{ˉ}{x}$ ±s]	10.60±3.64	10.23±3.94	11.10±4.10	9.87±3.13	9.90±3.85	9.97±3.70
MP[J/min，M（QL，QU）]	12.91[11.80，15.35]	11.41[10.42，13.88]	11.88[10.34，14.17]	15.90[11.77，17.89]	12.90[10.45，14.13]	10.29[8.69，12.45]^a

参数	β 值	χ ² 值	95%CI	P 值
HVHF+CHVHF（以HVHF）为参考	0.174	51.782	0.127～0.221	0.048
女性（以男性为参考）	-0.036	1.155	-0.102～0.032	0.283
年龄	0.001	0.027	-0.002～0.002	0.870
APACH Ⅱ	-0.005	4.649	-0.009～0	0.031
WBC	0.003	5.639	0.001～0.006	0.018
MP 基线	0.565	91.617	0.449～0.681	＜0.001
时间点（以t0 为参考）
24 h	-0.146	22.842	-0.205～-0.087	＜0.001
48 h	-1.189	53.186	-1.508～-0.869	＜0.001

参数	β 值	χ ² 值	95%CI	P 值
HVHF+ CHVHF（以HVHF）为参考	-0.671	24.215	-1.134～-0.208	＜0.001
女性（以男性为参考）	-0.404	3.816	-1.000～0.192	0.051
年龄	0.000	0.008	-0.087～0.087	0.928
APACH Ⅱ	-0.003	0.151	-0.074～0.068	0.697
WBC	0.006	1.416	-0.058～0.069	0.234
氧合指数	-0.001	0.891	-0.061～0.060	0.345
IL-6 基线	0.662	139.995	0.552～0.772	＜0.001
时间点（以t0 为参考）
24 h	-0.713	22.906	-1.165～-0.261	＜0.001
48 h	-1.196	55.176	-1.738～-0.654	＜0.001

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