Effect Of Clinical Status Of CRRT Initiation And Filter Selection On Prognosis Of Patients With Sepsis

Objective: The objective of this study was to investigate the effects of initiating timing of continuous renal replacement therapy(CRRT)and filter selection on the prognosis of patients with sepsis.Methods: We retrospectively collected sepsis patients treated with CRRT in the First Affiliated Hospital of Xinjiang Medical University.Collected Univariate analysis of clinical data,and performed univariate analysis.Multivariate logistic regression analysis was carried out for the indicators with statistical significance of difference among single factors.Then selected a meaningful combination of multiple factors,and constructed a new joint predictor(Prediction probability P).We used Receiver operating characteristic curve(ROC)to compare the area under ROC curve(AUC)of with primary indicators and other sepsis related scores.Patients were divided into two groups(High aCCI group and low aCCI group)using the optimal truncation value of the age-adjusted Charlson comorbidity index(aCCI)corresponding to the most approximate entry index.P<0.05 was considered statistically significant.Results:67 patients with sepsis who underwent CRRT were included in this study,including 52 males and 15 females.Age(52.2±13.0)years;32 cases died within 28 days after admission.1.In the univariate analysis,Intergroup aCCI,proportion of patients with or without surgery,proportion of patients with or without vasoactive drugs before penetration,number of days with vasoactive drugs before penetration,duration of mechanical ventilation before penetration,proportion with or without circulatory failure before penetration,q SOFA,NEWS,SOFA,APACHE Arterial II score,maximum pulse rate,shock index,oxygen absorption concentration,RDW,Arterial blood gas lactate(Abg-Lac)(all P < 0.05)in the death group were higher than those in the survival group.The aCCI 10-year mortality predicted value(aCCI live-10years),GCS score,lactic acid clearance 24 hours before penetration,minimum MAP value,minimum SBP value,oxygen saturation,Scr(P < 0.05)were all lower in death group than in survival group.2.In multi-factor combination,aCCI live-10 years combined Scr was an independent risk factor for predicting death(OR <1,and P <0.05).The AUC of new joint predictor in predicting sepsis was higher than that of aCCI live-10 years,Scr,APACHE Ⅱ,SOFA,GCS,q SOFA,and NEWS scores(0.798 vs.0.656,0.737,0.687,0.660,0.735,0.700,0.699).3.There were 20 patients in the high aCCI group and 46 patients in the low aCCI group,including 14 patients in the high aCCI group and 17 patients in the low aCCI group.Among patients with low aCCI,o Xiris treatment was associated with a lower mortality rate at 28 days(P < 0.05).There was no such finding in the high-ACCi group.Conclusions: 1.The short-term prognosis of patients with sepsis is significantly affected by the basic complications at the initiation of CRRT,whether recent surgery is performed,important scores related to sepsis,kidney function,respiratory function,tissue blood perfusion level,hemodynamic parameters,inflammation and nutritional parameters.2.new joint predictor has better predictive value than the two original indexes,APACHE Ⅱ,SOFA,GCS,q SOFA and NEWS scores.3.In sepsis patients with low aCCI,o Xiris treatment compared with AN69 membrane material can reduce the 28 d mortality of sepsis patients.