Observational Study Of Hemoperfusion Combined With Continuous Veno-Venous Hemofiltration In The Treatment Of Patients With Sepsis Asociated Acute Kidney Injury

Objective:The purpose of this study was to investigate the effect of hemoperfusion(HP)combined with continuous venovenous hemofiltration(CVVH)on the clinical effect of sepsis-associated acute kidney injury.Methods:Using the method of prospective analysis,50 patients with sepsis-associated acute kidney injury treated in the Department of severe Medicine,the first affiliated Hospital of Shanxi Medical University(from January 2021 to July 2022)were randomly divided into two groups: HP combined with CVVH(experimental group,n = 25)and CVVH(control group,n = 25).The changes of APACHEII and SOFA score,white blood cell(WBC),C-reactive protein(CRP),procalcitonin(PCT),mean arterial pressure(MAP),dosage of norepinephrine,creatinine and urine volume were compared between the two groups before treatment,24 hours and 72 hours after treatment.Case fatality rate within 28 days,ICU hospitalization time and total hospitalization days were compared between the two groups.The plasma levels of interleukin-6(IL-6),IL-8 and tumor necrosis factor-α(TNF--α)were measured before treatment,12 hours and 24 hours after treatment.Results:1.There was no significant difference in sex,age,clinical manifestation and severity between the two groups before treatment(P > 0.05).2.The vital signs of patients in both groups were improved after hemofiltration treatment for 72 hours.After 24 hours treatment,the heart rate and APACHEII score of the combined group were significantly lower than those of the control group,and the difference was statistically significant(P<0.05).The MAP of the combined group increased gradually after 72 hours of treatment,which was statistically significant compared with the control group(P<0.05),and the dose of norepinephrine gradually decreased compared with the control group(P<0.05).3.After hemofiltration treatment,IL-6,IL-8,TNF-α and CRP,PCT,WBC decreased in both groups.After 12 and 24 hours of treatment,the levels of IL-6,IL-8 and TNF-αdecreased in both groups(P<0.05),especially in HP+CVVH group(P<0.05).After 72 hours of treatment,compared with the control group,the levels of CRP,PCT and WBC in the experimental group decreased more significantly(P<0.05).4.The APACHE Ⅱ score and SOFA score of the two groups decreased after 72 hours of hemofiltration treatment,and there was significant difference between the combined group and the control group(P<0.05).5.After treatment,creatinine decreased and urine volume did not increase significantly in both groups,but there was no significant difference in creatinine and urine volume between the two groups(P>0.05).6.There was no significant difference in ICU stay time,total length of hospital stay and 28-day mortality between the two groups(P>0.05).Conclusions:1.Compared with CVVH treatment,HP combined with CVVH treatment can effectively improve the clinical symptoms of SA-AKI patients,effectively correct the body’s inflammatory response state,reduce the level of inflammatory factors in patients early,reduce APACHEII and SOFA scores,and stabilize hemodynamics to a certain extent.2.Compared with CVVH treatment,early HP combined with CVVH treatment had no significant improvement in renal function,including creatinine,and urine output in the short term,and had no significant impact on clinical prognosis,including in-hospital mortality,ICU length of stay,and total length of hospital stay.