Effects Of Different Anticoagulants On HMGB1 In The Treatment Of Septic Acute Kidney Injury Requiring CRRT

Objective:To compare and analyze the clinical efficacy of sodium citrate and heparin in patients with sepsis acute kidney injury requiring continuous renal replacement therapy(CRRT),and the clearance effect of citric acid and heparin on inflammatory factors such as high mobility group protein B1(HMGB1),so as to provide a new direction for the treatment of patients with acute sepsis kidney injury.Methods: From November 2021 to November 2022,60 patients with septic acute kidney injury requiring CRRT in intensive care department of the affiliated hospital of Yun Nan University were selected as research objects and randomly divided into control group and experimental group by random number table method.On the basis of routine CRRT,patients in both groups received systemic anticoagulation with ordinary heparin in the control group.The experimental group was treated with 4% sodium citrate for local anticoagulation.Vital signs,organ function indices,inflammatory indexes,prognostic scores and survival rate of the two groups were compared by Enzyme linked immunosorbent assay assay(ELISA)was used to measure the expression levels of HMGB1 and Neutrophil gelatinase associated lipocalin(NGAL)and the clearance rate of inflammatory factors in 2groups at different time points after CRRT treatment.Results:1.Characteristics of population informatics: General data such as gender,age,site of infection,height,weight and BMI were compared between the two groups,and no significant differences were found between the two groups(P>0.05).2.Vital signs: There was no significant difference between the two groups of patients in terms of various vital signs before the CRRT(P>0.05).The heart rate and respiratory rate of patients in the two groups at 6h,24 h,48h and 72 h after the CRRT were significantly lower than those before the CRRT,and the experimental group was lower than the control group(P<0.05).The oxygenation index were significantly higher than those before the CRRT,and the experimental group was higher than the control group(P<0.05),However,the temperature and mean arterial pressure had no significant change(P>0.05);3.Organ function indexes(liver and renal function,blood lactic acid): By comparing liver function indexes of the two groups at different times,it was found that the ALT and AST levels of the two groups were significantly decreased at 6h,24 h,48h and 72 h after using the CRRT compared with before using the CRRT(P<0.05).,but there was no significant difference in ALT and AST levels between the two groups at different time before and after CRRT;By comparing renal function indexes of the two groups at different times,it was found that BUN and Scr levels of the two groups of patients were not significantly different before the CRRT(P>0.05),and BUN and Scr levels of the two groups of patients were significantly decreased at 6h,24 h,48h and 72 h after the CRRT(P<0.05),BUN and Scr levels of experimental group were lower than those of control group at all time points(P<0.05).By comparing the lactic acid levels of the two groups at different time,it was found that the lactic acid levels of the two groups at 6h,24 h,48h and 72 h after using the CRRT were significantly decreased(P<0.05),but there was no significant difference between the two groups before and after using the CRRT at different time(P>0.05);4.Inflammatory indexes: The leukocyte level of patients in the two groups increased significantly 6 hours after CRRT compared with that before CRRT((P>0.05),and gradually decreased from 24 hours after CRRT operation.There was no significant difference between72 hours after CRRT and that before CRRT((P>0.05).The leukocyte water in the experimental group was lower than that in the control group 6 hours,24 hours,48 hours and72 hours after CRRT(P<0.05).The percentage of neutrophils,neutrophil/lymphocyte ratio(NLR),procalcitonin(PCT)and C-reactive protein(CRP)of the two groups of patients at 6h,24 h,48h and 72 h after the CRRT were significantly lower than those before the CRRT,The experimental group was lower than the control group(P<0.05),5.Expression of HMGB1 and NGAL: There was no significant difference between the two groups in the expression levels of HMGB1 and NGAL before CRRT(P>0.05),but the expression levels of HMGB1 and NGAL in the two groups at 6h,24 h,48h and 72 h after CRRT were significantly lower than those before CRRT(P<0.05),and the experimental group was lower than the control group(P<0.05);6.Clearance rate of inflammatory factors: The clearance rates of NLR,HMGB1 and PCT in the experimental group at 6h,24 h,48h and 72 h after CRRT were higher than those in the control group(P<0.05);7.Prognostic score: There was no significant difference between the two groups in the scores of acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ)and sequential organ failure assessment(SOFA)before treatment(P>0.05),and the scores of APACHE-Ⅱ and SOFA after CRRT were significantly lower than those before CRRT(P<0.05),And the experimental group was lower than the control group(P<0.05);8.Survival rate: The survival rate of the experimental group was 83.33%,slightly higher than 76.67% of the control group,but there was no statistical significance between groups(P>0.05).Conclusion: In the treatment of CRRT in patients with sepsis acute kidney injury,compared with the systemic anticoagulation of heparin,the local anticoagulation of citric acid can significantly relieve the inflammatory manifestations of patients,slow down the heart rate and respiratory rate,improve the oxygenation index,improve the inflammatory indicators such as WBC,PCT,CRP,reduce the expression levels of inflammatory factor HMGB1 and kidney injury marker NGAL,and then further improve the prognosis of patients,it has certain guiding significance for the selection of anticoagulant program in CRRT treatment.