A Retrospective Study Of Continuous Blood Purification Therapy In Sepsis Patients Caused By Abdominal And Lung Infections

Objective:To study the effect of sepsis caused by abdominal infections comparing with lung infections treated by continuous blood purification.To investigate the correlation of the data of patients with sepsis patients,sepsis of abdominal infections and lung infections patients and their prognosis.Methods:Collected clinical data of41patients with abdominal infections and lung infections of sepsis including severe sepsis and sepsis shock treated by continuous blood purification from2008January to2013December in intensive care unit of Shangdong Provincial Hospital.The patients were grouped according to the sepsis causes, namely abdominal infections group and lung infections group.Their clinical data before underwent blood purification therapy and the data48hours after it were collected.The data of two groups include vital signs,arterial blood gas analysis,blood routine, coagulation function and blood biochemistry.The differences between the two groups were analyzed,then multinomial logistic regression as well as univariate logistic regression analysis were conducted to explore the prognosis factors. In addition, collected relevant outcomes such as hemofiltration time,duration of mechanical ventilation,length of ICU stay,length of hospital stay,ICU mortality,28-day mortality,90-day mortality to compare the different outcome effects between the two groups after CRRT initiation.Results:41patients with severe sepsis and underwent blood purification therapy were selected.After48hours continuous venovenous hemofiltration,the septic patients showed clinical improvement,with statistically significant improvement in temperature, heart rate, oxygenation index, pH, creatinine, blood urea nitrogen,albumin,and blood platelet, the abdominal infections group in heart rate,pH,creatinine,blood urea nitrogen,albumin,blood platelet,the lung infections group in heart rate,oxygenation index,lactates,creatinine,blood urea nitrogen,albumin. About the relevant outcomes, only the duration of mechanical ventilation that the lung infections group was significantly longer than that of the abdominal infections group, the difference was statistically significant.Multivariate logistic regression analysis showed that risk factors of sepsis included combined septic shock(OR=9.820,95%CI1.201-80.287),with oliguria (OR=8.373,95%CI1.030-68.068),number of organ dysfunctions(OR=2.404,95%CI1.002-5.769).The risk factors of abdominal infections sepsis included application of norepinephrine(OR=10.528,95%CI2.549-201.766),number of organ dysfunctions(OR=3.203,95%CI1.922-11.134).The risk factors of lung infections sepsis included with oliguria(OR=21.666,95%CI1.237-379.342),number of organ dysfunctions(OR=2.491,95%CI1.867-7.158).Conclusion:1. Continuous blood purification treatment in patients with sepsis could more effectively remove proinflammatory mediators,improve high metabolic state,hemodynamics,pulmonary function and nutritional status.2. Compared with abdominal infections group,CRRT could more effectively improve oxygenation index of lung infections group.3. Combined septic shock,with oliguria,number of organ dysfunctions and application of norepinephrine could predict the prognosis of severe sepsis.4. For patients with severe sepsis, whether abdominal or lung infection, it is recommended the application of blood purification treatment at the right time to improve the prognosis.