The Plasma Level And Biomarker Value Of Procalcitonin During Continuous Venovenous Hemofiltration In Severe Intra-abdominal Infections Patients

Objective:To assess whether plasma procalcitonin(PCT)is cleared by high-volume hemofiltration sufficiently to affect its plasma levels and biomarker value in severe intra-abdominal infections patients,and to assess the mass transfer and clearance of PCT.Methods:Prospective collected clinical data of patients with severe intra-abdominal infections treated by continuous venovenous hemofiltration(CVVH)from 2013 October to 2015 October in Department of General Surgery,Jinling Hospital,Nanjing,China.The patients were divided into two groups according to the dose of CVVH:standard-volume group hemofiltration(SVHF,2000ml/h),high-volume hemofiltration group(HVHF,4000ml/h).All patients were used high-flux synthetic membranes(AV600S)and through post dilution route.After 15 minutes,1h,3h,6h,12h and 24h of CVVH,samples were collected from prefilter and postfilter(in-and outlet)blood and ultradiafiltrate.Mass transfer was determined and the clearance and the sieving coefficient were calculated according to the mass conservation principle.The receiver operating characteristic curve were conducted to assess the prognosis value of PCT.Results:A total of 41 AKI patients were randomly assigned to SVHF group(n=16)or HVHF group(n=25).The PCT was detected in the ultrafiltrate,and the levels of PCT in SVHF group were significantly lower than HVHF group,and decreased over time during hemofiltration.As the serum PCT level in front of the filter,high-volume group are lower than conventional group in each phase,though there was no statistical difference.The total mass removal rate of PCT was higher for high-volume group than the conventional groups and this difference were no significant altered over time.The mass adsorption rate decreased in conventional group over time,as compared to the high-volume groups.The sieving coefficient reached a peak 3 hours after hemofiltration and declined during the rest time in SVHF group.In the subgroup analysis,concentrations of PCT at inlet and outlet in no-survivors were significantly higher than survivors at each of the time points.The optimized threshold level serum PCT at baseline were 30.5 ng/ml and T24h were 23.4ng/ml in SVHF group,and at baseline were 30.9 ng/ml and T24h were 15.9ng/mL in HVHF group.Conclusion:Compared with standard-volume group,high-volume CVVH could more effectively eliminate PCT from serum,removal efficiency gradually reduce over time.Most of the mass is eliminated by convective flow,but adsorption also contributes to elimination during the early phase of CVVH.The effect on the plasma concentration of PCT in sIAI patients with high-volume CVVH is considerable.Thus,clinicians for clinical decisions should be taken into consideration.