Application Of Adsorptive Continuous Renal Replacement Therapy Hemofilter In Patients With Septic Shock Complicated With Acute Kidney Injury

Objective : To evaluate the clinical effect of using o Xiris hemofilter with endotoxin and inflammatory factor adsorption properties for continuous renal replacement therapy(CRRT)in patients with septic shock complicated with acute kidney injury(AKI).Methods:Selected patients suspected of gram-negative bacteria infection with septic shock complicated with AKI admitted to the Intensive Care Unit(ICU)of Tongji Hospital affiliated to Huazhong University of Science and Technology from January2018 to December 2019,were treated with CRRT using o Xiris filter for 48 h,as the o Xiris group.From January 2017 to December 2018,patients who received CRRT with conventional filter were selected as the control group,who met the same inclusion and exclusion criteria.The changes of plasma inflammatory factors and organ function indicators in the two groups during the CRRT treatment period were compared and analyzed,as well as the ICU mortality and hospital mortality of the two groups of patients.Results:A total of 45 patients were enrolled in this study,and all of them received CRRT treatment.Among them,20 patients received CRRT treatment with o Xiris filter,as the o Xiris group;the remaining 25 patients received CRRT treatment with conventional filter,as the control group.The source of septic infection of all enrolled patients were from the abdomen,31 patients(68.9%)were cultured with Escherichia coli or Klebsiella.In contrast with the control group,the duration of vasoactive drugs using in o Xiris group was significantly reduced(6.1±1.3 days vs 4.5±1.5 days,t=3.332,P=0.004),and the CRRT duration was significantly reduced(6.6±2.1 days vs 4.8±1.8days,t=2.386,P=0.022).After 48 hours of CRRT treatment,the sequential organ failure assessment scores,norepinephrine dosage,blood lactate(LAC),IL-6,IL-8 and TNF-αlevels of o Xiris group were significantly decreased(t values are 3.864,2.347,2.624,3.464,2.670,2.479;P values are 0.004,0.018,0.015,0.003,0.015,0.023).However,there were no conspicuous differences in ICU length of stay,total length of stay,ICU mortality rate and hospital mortality rate between the two groups(t values are 1.649,0.821,0.818,0.627;P values are 0.225,0.402,0.366,0.428).Conclusions:Compared with conventional hemofilter,using o Xiris hemofilter for CRRT treatment is more effective in clearing plasma inflammatory factors and improving organ function in patients with septic shock complicated with AKI.