Efficacy And Timing Of Patients With Sepsis Undergoing High Volume Hemofiltration Therapy

Objective:To evaluate the efficacy of patients with sepsis undergoing high volume hemofiltration(HVHF) therapy, explore the risk factors affecting the prognosis of sepsis, and analyze the relationship of the prognosis of patients with sepsis and the existence of different phases of acute kidney injury (AKI) before treatment.Methods:84patients with sepsis undergoing HVHF were chosen from Shandong Provincial Hospital Critical Care Medicine during2010.1～2014.1, and we retrospectively analyzed clinical data of patients, scores and clinical indicators of treatment before and24h、48h、72h and28d after treatment. According to the survival rates of patients in the28th day, patients were divided into survival group and death group. We compared the changes in clinical indicators before and after treatment in the groups in order to evaluate the efficacy of HVHF in patients with sepsis. Also, we compared the differences in clinical data before treatment between the groups, and analyze the relationship of sepsis accompanied by different phases of AKI before treatment and their prognosis.Results:Among the84patients with sepsis,45patients are alive after28d, and39patients died. Among them,21patients are without AKI, and16,16and39patients with AKI are phase Ⅰ、Ⅱ、Ⅲ respectively.1. After patients with sepsis underwent HVHF treatment, two groups of patients’ body temperature (T), heart rate (HR), respiratory (R), serum creatinine (SCr), urea nitrogen (BUN), potassium (K+), blood lactic acid (Lac), APACHE II score was significantly decreased, the P<0.05, the difference was statistically significant. Arterial blood oxygen partial pressure (PaO2), oxygenation index (PaO2/FiO2), PH was increased significantly, the P<0.05, the difference was statistically significant.2. Survival group and death group clinical data comparison shows:AKI stage is associated with the prognosis of patients with sepsis complicated with AKI condition is heavier, the higher mortality rate, P=0.042<0.05, the difference was statistically significant. Death group patients’ age, basic diseases cases, the numbers of organ failure before treatment, Cys-C,, blood Lac and APACHE Ⅱ score were higher than in survival group, P<0.01, the difference was statistically significant.. Among them, the numbers of organ failure before treatment [ExP (beta)=0.116, t=2.681, P=0.009) and APACHE Ⅱ score [ExP (beta)=0.033, t=4.067. P<0.001] are independent risk factors affect the prognosis of patients.3. The Cys-C with APACHE Ⅱ score and Lac level with APACHE II score before treatment are analysed in linear correlation analysis. Results showed that Cys-C and Lac before treatment and the APACHE II score correlation coefficient respectively, p=0.463,0.575, P<0.01, the difference was statistically significant.4. The mortality rate of patients without AKI and AKI phase Ⅰ、Ⅱ、Ⅲ are23.81%,37.50%,56.25%,61.29%. For different AKI phases patients before treatment with ANOVA analysis, results show that the different AKI phases patients, there was no significant difference in age; The numbers of organ failure, Cys-C, Lac and APACHE Ⅱ score significant differences in different AKI phases. Sepsis patients with kidney damage is aggravating when the numbers of organ failure, Cys-C, Lac and APACHE Ⅱ score were significantly increased, the difference was statistically significant. The relationship among different AKI phases and28days end is determined by using chi-square test, the results shows that with the AKI worsing, patients mortality increased significantly, P<0.05, the difference was statistically significant.Conclusion: 1. HVHF therapy is an effective treatment for patients with sepsis, and has important clinical value.2. The patients’age, basic diseases, the numbers of organ failure before treatment, Cys-C,Lac,lactic APACHE II score are associated with the prognosis of patients with sepsis, among them, the numbers of organ failure before treatment and APACHE II score are independent risk factors affect the prognosis of patients.3. Cys-C and Lac levels before treatment are positively correlated with APACHE II score, patients’Cys-C and Lac levels before treatment can be used as evaluation index of prognosis of patients.4. AKI phases is associated with the prognosis of sepsis patients with AK.I, early HVHF therapy can effectively improve the prognosis of patients with sepsis.