Effect of combined blood purification on serum inflammatory cytokines levels and clinical prognosis in patients with sepsis

doi:10.3877/cma.j.issn.1674-6880.2023.04.002

Abstract

Abstract:

Objective

To explore the effect of combined blood purification on the levels of inflammatory cytokines and clinical prognosis in patients with sepsis.

Methods

From December 2020 to August 2021, 28 patients with sepsis undergoing blood purification in the First Affiliated Hospital of Xinjiang Medical University were randomly divided into three groups: oXiris group (10 cases), HA380 group (7 cases) and oXiris + HA380 group (11 cases) by random stratification. The oXiris group was treated with continuous veno-venous hemodiafiltration (CVVHDF) with the oXiris filter, the HA380 group was treated with CVVHDF blood adsorption by the ST100 filter combined with HA380 hemoperfusion, and the oXiris + HA380 group was treated with CVVHDF blood adsorption by the oXiris filter combined with HA380 hemoperfusion. The inflammatory cytokine indexes of interleukin-6 (IL-6), procalcitonin (PCT), high mobility group protein 1 (HMGB1) and interferon-gamma (IFN-γ) were recorded at 0, 2, 4, 6, 12, 24 and 48 h after continuous renal replacement therapy (CRRT) treatment respectively. The sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were recorded at 0, 24 and 48 h after CRRT treatment. At the same time, the survival status was followed up for 28 days.

Results

The levels of PCT (F = 18.507, P < 0.001), HMGB1 (F = 3.831, P = 0.035) and IFN-γ (F = 5.549, P = 0.010) among the three groups at each time point showed significant differences. However, there were no significant differences in IL-6, SOFA and APACHEⅡ scores among the three groups at each time point (F = 0.628, 0.489, 0.960; P = 0.542, 0.621, 0.397). Further pairwise comparison found that the PCT level in the oXiris + HA380 group decreased significantly after 48 h of treatment compared with the beginning of treatment, but it was still higher than that in the HA380 group at the same time (both P < 0.05). The levels of HMGB1 and IFN-γ in the oXiris + HA380 group were much lower than those in the HA380 group after 48 h of treatment (both P < 0.05), but the difference was not statistically significant compared with the oXiris group at the same time (both P > 0.05). After 28 days of follow-up, six patients survived in the oXiris group, four patients survived in the HA380 group, and five patients survived in the oXiris + HA380 group. There was no statistically significant difference in survival among the three groups (χ² = 0.493, P = 0.781).

Conclusion

oXiris combined with HA380 hemoperfusion can remove inflammatory cytokines in the serum of patients with sepsis to a certain extent, but it has no significant effect onprognosis.

Key words: Sepsis, Blood purification, Continuous renal replacement therapy, Inflammatory cytokines, Prognosis

Yuanyuan Han, Sabeiti Reziya, Zhijie Mao, Aierken Mufunayi, Chen Lu, Xiaohong Sang, Mulati Aerman, Li Zhang. Effect of combined blood purification on serum inflammatory cytokines levels and clinical prognosis in patients with sepsis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(04): 272-278.

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References 32

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组别	例数	年龄（岁， ± s）	男/女（例）	感染情况（例）				合并疾病（例）
组别	例数	年龄（岁， ± s）	男/女（例）	肺部感染	腹腔感染	泌尿系统感染	软组织感染	高血压	糖尿病	慢性肾脏疾病	肝功能不全
oXiris组	10	58 ± 11	8/2	7	4	2	2	2	3	3	2
HA380组	7	60 ± 29	4/3	6	4	1	1	4	2	5	1
oXiris + HA380组	11	61 ± 20	9/2	8	9	5	3	2	6	4	6
F/χ²值		0.110	1.597	0.592	3.980	2.596	0.447	3.742	1.722	3.198	4.231
P值		0.909	0.450	0.744	0.143	0.273	0.800	0.154	0.412	0.202	0.121
组别	例数	并发症（例）						病原体类型（例）			28 d生存
组别	例数	呼吸衰竭	心力衰竭	急性肝损伤	急性肾损伤	电解质紊乱	脓毒性休克	革兰阴性菌	革兰阳性菌	真菌	28 d生存
oXiris组	10	8	6	7	10	2	6	7	2	5	6
HA380组	7	2	2	4	4	2	2	2	1	2	4
oXiris + HA380组	11	5	4	8	9	4	6	6	1	3	5
F/χ²值		4.859	1.973	0.590	5.157	0.687	1.777	2.848	0.509	1.386	0.493
P值		0.088	0.373	0.775	0.076	0.709	0.411	0.241	0.775	0.500	0.781

组别	例数	年龄（岁， ± s）	男/女（例）	感染情况（例）				合并疾病（例）
组别	例数	年龄（岁， ± s）	男/女（例）	肺部感染	腹腔感染	泌尿系统感染	软组织感染	高血压	糖尿病	慢性肾脏疾病	肝功能不全
oXiris组	10	58 ± 11	8/2	7	4	2	2	2	3	3	2
HA380组	7	60 ± 29	4/3	6	4	1	1	4	2	5	1
oXiris + HA380组	11	61 ± 20	9/2	8	9	5	3	2	6	4	6
F/χ²值		0.110	1.597	0.592	3.980	2.596	0.447	3.742	1.722	3.198	4.231
P值		0.909	0.450	0.744	0.143	0.273	0.800	0.154	0.412	0.202	0.121
组别	例数	并发症（例）						病原体类型（例）			28 d生存
组别	例数	呼吸衰竭	心力衰竭	急性肝损伤	急性肾损伤	电解质紊乱	脓毒性休克	革兰阴性菌	革兰阳性菌	真菌	28 d生存
oXiris组	10	8	6	7	10	2	6	7	2	5	6
HA380组	7	2	2	4	4	2	2	2	1	2	4
oXiris + HA380组	11	5	4	8	9	4	6	6	1	3	5
F/χ²值		4.859	1.973	0.590	5.157	0.687	1.777	2.848	0.509	1.386	0.493
P值		0.088	0.373	0.775	0.076	0.709	0.411	0.241	0.775	0.500	0.781

组别	例数	IL-6（ng/L）	PCT（μg/L）	HMGBI（ng/L）	IFN-γ（ng/L）	SOFA评分（分）	APACHEⅡ评分（分）
oXiris组
0 h	10	477 ± 268	36.0 ± 22.3	1 044 ± 1 014	20.5 ± 3.2	14 ± 5	23 ± 7
2 h	10	396 ± 221	25.2 ± 18.0	535 ± 318	25.6 ± 12.2	-	-
4 h	10	410 ± 313	29.6 ± 15.5	902 ± 503	23.0 ± 12.2	-	-
6 h	10	414 ± 288	37.2 ± 17.4	1 201 ± 489^e	12.5 ± 1.8^deh	-	-
12 h	10	338 ± 179	44.5 ± 27.5	1 104 ± 879^e	13.8 ± 2.8^deh	-	-
24 h	10	334 ± 190	31.9 ± 11.2	1 301 ± 897^e	15.0 ± 3.0	14 ± 4	19 ± 6
48 h	10	311 ± 214	23.1 ± 9.2^a	591 ± 180^afg	14.0 ± 2.0^deh	12 ± 5	17 ± 5
HA380组
0 h	7	412 ± 229	5.7 ± 2.8^b	902 ± 427	52.5 ± 39.5^b	12 ± 4	26 ± 6
2 h	7	383 ± 290	5.2 ± 1.9^b	702 ± 432	26.3 ± 19.0^d	-	-
4 h	7	523 ± 345	5.8 ± 1.2^b	930 ± 523	25.0 ± 17.0^d	-	-
6 h	7	454 ± 340	6.0 ± 2.5^b	770 ± 325	26.0 ± 11.5^bd	-	-
12 h	7	460 ± 236	7.9 ± 3.0^b	641 ± 240	20.4 ± 5.8^bd	-	-
24 h	7	489 ± 218	8.6 ± 7.7^b	738 ± 277	22.0 ± 6.8^bd	11 ± 4	23 ± 6
48 h	7	485 ± 286	7.7 ± 7.6^b	748 ± 209	20.8 ± 7.6^bd	10 ± 4	21 ± 5
oXiris + HA380组
0 h	11	655 ± 241	41.4 ± 17.4^c	675 ± 281	27.7 ± 23.5^c	13 ± 5	22 ± 6
2 h	11	482 ± 337	38.0 ± 21.0^c	581 ± 375	17.1 ± 10.0^d	-	-
4 h	11	346 ± 281	30.3 ± 25.2^c	524 ± 309	15.2 ± 8.0^d	-	-
6 h	11	412 ± 199	34.6 ± 24.2^c	575 ± 421^b	13.8 ± 3.8^cd	-	-
12 h	11	277 ± 139	23.9 ± 14.0^c	614 ± 150^b	10.7 ± 4.1^cd	-	-
24 h	11	290 ± 181	27.3 ± 18.4^c	516 ± 266^b	11.7 ± 5.8^cd	12 ± 4	19 ± 7
48 h	11	324 ± 238	19.5 ± 11.1^cd	445 ± 134^c	12.2 ± 5.4^cd	11 ± 4	18 ± 6
F值		0.628	18.507	3.831	5.549	0.489	0.960
P值		0.542	<0.001	0.035	0.010	0.621	0.397

组别	例数	IL-6（ng/L）	PCT（μg/L）	HMGBI（ng/L）	IFN-γ（ng/L）	SOFA评分（分）	APACHEⅡ评分（分）
oXiris组
0 h	10	477 ± 268	36.0 ± 22.3	1 044 ± 1 014	20.5 ± 3.2	14 ± 5	23 ± 7
2 h	10	396 ± 221	25.2 ± 18.0	535 ± 318	25.6 ± 12.2	-	-
4 h	10	410 ± 313	29.6 ± 15.5	902 ± 503	23.0 ± 12.2	-	-
6 h	10	414 ± 288	37.2 ± 17.4	1 201 ± 489^e	12.5 ± 1.8^deh	-	-
12 h	10	338 ± 179	44.5 ± 27.5	1 104 ± 879^e	13.8 ± 2.8^deh	-	-
24 h	10	334 ± 190	31.9 ± 11.2	1 301 ± 897^e	15.0 ± 3.0	14 ± 4	19 ± 6
48 h	10	311 ± 214	23.1 ± 9.2^a	591 ± 180^afg	14.0 ± 2.0^deh	12 ± 5	17 ± 5
HA380组
0 h	7	412 ± 229	5.7 ± 2.8^b	902 ± 427	52.5 ± 39.5^b	12 ± 4	26 ± 6
2 h	7	383 ± 290	5.2 ± 1.9^b	702 ± 432	26.3 ± 19.0^d	-	-
4 h	7	523 ± 345	5.8 ± 1.2^b	930 ± 523	25.0 ± 17.0^d	-	-
6 h	7	454 ± 340	6.0 ± 2.5^b	770 ± 325	26.0 ± 11.5^bd	-	-
12 h	7	460 ± 236	7.9 ± 3.0^b	641 ± 240	20.4 ± 5.8^bd	-	-
24 h	7	489 ± 218	8.6 ± 7.7^b	738 ± 277	22.0 ± 6.8^bd	11 ± 4	23 ± 6
48 h	7	485 ± 286	7.7 ± 7.6^b	748 ± 209	20.8 ± 7.6^bd	10 ± 4	21 ± 5
oXiris + HA380组
0 h	11	655 ± 241	41.4 ± 17.4^c	675 ± 281	27.7 ± 23.5^c	13 ± 5	22 ± 6
2 h	11	482 ± 337	38.0 ± 21.0^c	581 ± 375	17.1 ± 10.0^d	-	-
4 h	11	346 ± 281	30.3 ± 25.2^c	524 ± 309	15.2 ± 8.0^d	-	-
6 h	11	412 ± 199	34.6 ± 24.2^c	575 ± 421^b	13.8 ± 3.8^cd	-	-
12 h	11	277 ± 139	23.9 ± 14.0^c	614 ± 150^b	10.7 ± 4.1^cd	-	-
24 h	11	290 ± 181	27.3 ± 18.4^c	516 ± 266^b	11.7 ± 5.8^cd	12 ± 4	19 ± 7
48 h	11	324 ± 238	19.5 ± 11.1^cd	445 ± 134^c	12.2 ± 5.4^cd	11 ± 4	18 ± 6
F值		0.628	18.507	3.831	5.549	0.489	0.960
P值		0.542	<0.001	0.035	0.010	0.621	0.397

组别	例数	IL-6（ng/L）	PCT（μg/L）	HMGBI（ng/L）	IFN-γ（ng/L）	SOFA评分（分）	APACHEⅡ评分（分）
生存组
0 h	15	549 ± 319	36 ± 24	749 ± 304	31 ± 8	12 ± 4	22 ± 7
2 h	15	432 ± 301	28 ± 23	594 ± 322	22 ± 14	-	-
4 h	15	382 ± 309	26 ± 24	810 ± 509	20 ± 13	-	-
6 h	15	417 ± 287	30 ± 22	950 ± 499	18 ± 10	-	-
12 h	15	356 ± 225	31 ± 27	771 ± 411	13 ± 6	-	-
24 h	15	319 ± 164	28 ± 17	801 ± 503	15 ± 4	11 ± 4	18 ± 6^a
48 h	15	358 ± 260	21 ± 13	599 ± 187	16 ± 7	10 ± 4	16 ± 5^a
死亡组
0 h	13	492 ± 291	23 ± 19	957 ± 903	33 ± 20	14 ± 5	26 ± 6
2 h	13	465 ± 260	21 ± 18	591 ± 396	23 ± 13	-	-
4 h	13	446 ± 304	21 ± 17	666 ± 394	21 ± 12	-	-
6 h	13	424 ± 242	24 ± 22	731 ± 460	16 ± 5	-	-
12 h	13	340 ± 168	24 ± 19	887 ± 787	16 ± 5	-	-
24 h	13	396 ± 234	19 ± 14	944 ± 783	17 ± 8	14 ± 4	23 ± 6^b
48 h	13	357 ± 216	14 ± 8	512 ± 260	14 ± 5	12 ± 3	20 ± 5^ab
F值		0.045	1.805	0.002	0.012	2.165	5.371
P值		0.834	0.191	0.962	0.915	0.153	0.028

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