Objective To investigate the effect of starting time of blood purification therapy and selection of filter on short-term prognosis of patients with sepsis. Methods:We retrospectively collected Patients with sepsis who received blood purification treatment in the First Affiliated Hospital of Xinjiang Medical University .Single factor analysis was collected on the index line on the start day.ROC curve was used to compare the prediction effect of each index, and the optimal threshold value was determined and grouped to analyze the 28d mortality rate with AN69/oXiris was analyzed in the higher/lower groups with different cut-off values. P＜0.05 was considered statistically significant. Results:Among the 66 patients, 31 died within 28 days of admission. Univariate analysis showed that aCCI, NEWS, SOFA, APACHE II(OR value was 1.380, 1.213, 1.141, 1.079; 95%CI was 1.035-1.838, 1.062-1.386, 1.005-1.297, 1.017-1.144; and P value was 0.028, 0.005, 0.042, 0.012) was the risk factor for death within 28 days; Scr(OR=0.994;95%CI=0.991-0.998;P=0.001) was a protective factor for death within 28 days; The AUC vaule of aCCI, NEWS, SOFA, APACHE II and Scr were 0.674, 0.698, 0.657, 0.679 and 0.736. 95%CI were 0.543-0.806、0.572-0.824、0.521-0.793、0.548-0.811、0.614-0.858, and the optimal cut-off values were 3.5, 14.5, 11.5, 19.5 and 418.98. In the low-aCCI group, 28d mortality was lower in patients treated with oXiris(χ2=4.572，P=0.032). Conclusion: 1. Patients with sepsis at the start of blood purification therapy had higher risk of death within 28 days with aCCI score above 3.5, NEWS score above 14.5, SOFA score above 11.5, APACHE II score above 19.5, and Scr score below 418.98μmol/L. 2. In sepsis patients with low aCCI, oXiris treatment compared with AN69 membrane material can reduce the 28d mortality of sepsis patients.
CHEN Xi
,
WAN Hong-Zhe
,
WU Shuo
,
ZHANG Li
. Effect of the start time of blood purification therapy and the selection of filter on short-term prognosis of the patients with sepsis[J]. Chinese Journal of Blood Purification, 2023
, 22(07)
: 493
-497
.
DOI: 10.3969/j.issn.1671-4091.2023.07.004
[1]Singer M, Deutschman CS, Seymour CW, et al.The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.
[2]Livigni S, Bertolini G, Rossi C, et al.Efficacy of coupled plasma filtration adsorption (CPFA) in patients with septic shock: a multicenter randomised controlled clinical trial. BMJ Open. 2014 Jan 8;4(1):e003536.
Mariano F, Hollo Z, Depetris N, et al. Coupled-plasma filtration and adsorption for severe bum patients with septic shock and acute kidney injury treated with renal replacement therapy [J]. Bums, 2020,46(1): 190-198.
[4]Xiaoming Li C L Z M, Zhou. Effectiveness of polymyxin B-immobilized hemoperfiision[J]. Journal of Critical Care, 2020,12(5):331-339.
[5]Charlson M, Szatrowski TP, Peterson J, et al. Validation of a com? bined comorbidity index［J］. J Clin Epidemiol, 1994, 47(11): 1245? 1251.
[6]Newman M, Hanson H, Schliep K, et al. Validating older adult morbidity trajectories using multiple comorbidity indices［J］. Innov Aging, 2020, 4(Suppl 1): 174?175.
[7]Oltean Simona,???ulescu Doina,Bondor Cosmina et al. Charlson's weighted index of comorbidities is useful in assessing the risk of death in septic patients.[J] .J Crit Care, 2012, 27: 370-5.
[8]盛松,张艳虹,马杭琨,等.查尔森合并症指数对合并急性肾损伤并接受连续肾脏替代治疗的脓毒症患者死亡风险的评估价值[J].临床急诊杂志,2021,22(11):764-771.
[9]Choi G, Gomersall CD, Tian Q, et al. Principles of antibacterial dosing in continuous renal replacement therapy [J]. Crit Care Med,2009, 37 (7): 2268-2282.
[10]Akhoundi A, Singh B, Vela M, et al. Incidence of adverse events during continuous renal replacement therapy [J]. Blood Purif, 2015, 39 (4): 333-339. DOI:10.1159/000380903.?
[11]Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renalreplacement therapy in the intensive care unit. N Engl J Med. 2016; 375(2):122-33.
[12]Gaudry S, Hajage D, Martin-Lefevre L, et al. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, openlabel, randomised, controlled trial. Lancet 2021; 397: 1293–300.
[13]Barbar SD, Binquet C, Monchi M, et al.. Impact on mortality of the timing of renal replacement therapy in patients with severe acute kidney injury in septic shock: the IDEAL-ICU study (Initiation of Dialysis Early versus Delayed in the Intensive Care Unit): study protocol for a randomized controlled trial. Trials 2014;15:270.
[14]Smith OM, Wald R, Adhikari NK, et al. Standard versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI): study protocol for a randomized controlled trial. Trials 2013;14:320.
[15]B M, C L, JA K. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices.[J]. Intensive care medicine experimental, 2018,6(1):12-20.
[16]李江涛，王爱丽，王立瑞，等. oXiris滤器在脓毒症急性肾损伤治疗中的应用评 价：病例系列研究[J].中华肾脏病杂志,2021(10):831-834.
[17]林新强. 应用oXiris滤器的连续性肾脏替代治疗救治脓毒症合并急性肾损伤患者的疗效观察[D].重庆医科大学,2021.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pr. 2012;120:c179–c184.
[19]Pasin L, Boraso S, Tiberio I. Early initiation of renal replacement therapy in critically ill patients: A meta-analysis of randomised clinical trials. BMC Anesthesiol. 2019;19(1):62.
廖小兰,王素萍,许卓伦,等.动脉和静脉血乳酸值关系探讨[J].实用医学杂志,1994(09):854.
[21]Zhang L, Cove M, Nguyen BG, et al..Adsorptive hemofiltration for sepsis management:expert recommendations based on the Asia Pacific experience. Chin Med J (Engl). 2021 Aug 16;134(18):2258-2260.
Mark R.Marshall,张凌,王敏敏,等.oXiris-内毒素吸附技术的临床应用[J].华西医学,2018,33(07):797-800.
[23]KN S, H B, J B, et al. Continuous Renal Replacement Therapy with oXiris? Membrane in Severe Ebstein-Barr Virus-Mediated Hemophagocytic Lymphohistiocytosis: A Case Report.[J] Blood purification, 2021,50:578-581.
[24]T W, Z C, P L, et al. Early use of endotoxin absorption by oXiris in abdominal septic shock: A case report.[J]- Medicine, 2020,99(28):e 19632.
