The Effects Of Cpfa On The Mods Patients With Sepsis

Aims: The aim of the study was to evaluate the effects of a novel extra-corporeal blood purification therapy—coupled plasma filtration absorption (CPFA) and compare with high-volume haemofiltration (HVHF) on the MODS patients with sepsis.Methods: 14 patients diagnosed MODS with sepsis were enrolled and randomly separated into HVHF and CPFA group. The two groups received 10 hours of HVHF or CPFA treatment, respectively. The parameters of hemodynamic, electrolytes and acid-base balance, SOFA and APACHEⅡscore after HVHF or CPFA were examined. The levels of serum HMGB-1, TNF-α, IL-1Ra and ICAM-1 were also detected at the start, at 5 and 10 hours of each treatment.Results: (1) After the two therapies, blood urea nitrogen (BUN) and serum creatinine (Cr) all significantly decreased, electrolytes and acid-base balance were well maintained, and no visible influence was found in WBC, PLT or HCT. (2) After CPFA, SOFA score and APACHEⅡscore were decreased dramatically (P<0.05), MAP and the oxygenation index (PaO2/FiO2) were improved significantly (P<0.05). However, after HVHF, only SOFA score was found markedly decreased (P<0.05), no significant changes were found in MAP, oxygenation index or APACHEⅡscore (P>0.05). (3) No therapy related adverse reactions such as haemorrhage, hypersensitiveness or embolism were noted even in the aged during the two treatments. The average estimated mortality of HVHF group was 52%, 4 patients survived, while the average estimated mortality of CPFA group was 56%, 6 patients survived. (4) Serum levels of HMGB-1, ICAM-1, IL-1Ra and TNF-αdecreased markedly after 10 hours of CPFA therapy (P<0.05). Within the HVHF group HMGB-1 and IL-1Ra decreased at 5 hours but did not continue at 10 hours (P<0.05). TNF-α, ICAM-1 did not markedly change with HVHF (P>0.05).Conclusions: Both HVHF and CPFA therapies improved the clinical manifestations of the MODS patients with sepsis, and the effect of CPFA was superior to HVHF, which had implications in the optimal treatment of blood purification therapy in MODS.