Overall efficacy of continuous renal replacement therapy in patients with multiple organ dysfunction syndrome without renal damage

doi:10.3877/cma.j.issn.2095-9133.2019.05.002

Abstract

Abstract:

Objective

To explore the efficacy of continuous renal replacement therapy (CRRT) in patients with multiple organ dysfunction syndrome (MODS) without renal damage.

Methods

A retrospective analysis was made of 190 MODS patients admitted to the emergency department of Sun Yat Sen Memorial Hospital of Sun Yat sen University from March 30, 2012 to February 1, 2018, including 113 males and 77 females, aged 14-97 years with an average age of (61.8) years. A total of 190 patients with MODS were divided into two groups: One group (87 patients, including 29 cases without renal injury) received conventional treatment including etiological treatment, anti-inflammatory treatment, organ function support and other measures; continuous renal replacement therapy was not selected as the conventional treatment group; another group in addition to routine therapy plus with continuous renal replacement therapy, as CRRT group, a total of 103 cases (including 20 patients without renal damage). Two groups of patients were compared before and after treatment for 24 h Marshall score, acute physiology and chronic health rating system Ⅱ (acute physiology and chronic health evaluation Ⅱ, APACHE Ⅱ) score, sequential organ failure (sequential outraged failure assessment, SOFA) score and 28d survival rate of the two groups. Comparison was also made between the two groups of patients without renal damage of 24 h before and after treatment of two subgroups Marshall score, APACHE Ⅱ score, SOFA score and survival rate to evaluate the effect of CRRT 28 days.

Results

Marshall score before and after the CRRT treatment group (7.2±2.6) and (6.7±2.8), APACHE Ⅱ score (24.0±7.8) and (19.7±7.5) and the SOFA score (11.8±2.6) and (10.7±3.1) were significantly decreased (P<0.05). The conventional treatment group before and after treatment Marshall score (7.0±3.0) and (7.2±3.0), APACHE Ⅱ score (23.1± 8.3) and(23.0±8.5) and the SOFA score (11.0±3.2) and (11.1±3.4) had no obvious changes. The survival rate of CRRT group was significantly improved at 28 days (P<0.05). Without renal damage of CRRT subgroups before and after treatment in patients with APACHE Ⅱ score (20.5±6.4) and (18.4 ±6.8) had also declined obviously (P<0.05). However, Marshall score (5.7±2.3) and (5.5±2.4) and SOFA score (10.0±2.8) and (9.5±3.2) showed no significant improvement (P>0.05). Without renal damage of conventional Marshall score before and after treatment the treatment group (6.9±3.2) and (7.2±3.2), APACHE Ⅱ score (21.9±8.2) and (21.7±9.0) and SOFA score (10.1±3.2) and (10.3 ±3.2) had no obvious improvement (P> 0.05), and no significant improved survival 28 days P>0.05.

Conclusions

Early line of continuous renal replacement therapy in the treatment of multiple organ dysfunction syndrome can obviously improve the patients’ condition, raise survival rate of the patients with mid-term but without the renal damage in patients with multiple organ dysfunction syndrome APACHE Ⅱ score can significantly drop, but Marshall grade, SOFA and 28 days survival rate have no significant improvement, and therefore it is not recommended.

Key words: Multiple organ dysfunction syndrome, Continuous renal replacement therapy, Mid-term survival rate

Kai Yu, Tianen Zhou, Pengfei Wang, Longyuan Jiang. Overall efficacy of continuous renal replacement therapy in patients with multiple organ dysfunction syndrome without renal damage[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2019, 05(05): 262-266.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwsyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9133.2019.05.002

https://zhwsyjdzzz.cma-cmc.com.cn/EN/Y2019/V05/I05/262

Figures/Tables 7

References 10

1	Ronco C, Bellomo R．Acute renal failure and multiple organ dysfunction in the ICU：from renal replacement therapy(RRT)to multiple organ support therapy (MOST)[J]．Int J Artifi Organs，2002，25(8)：733-747.
2	Ronco C, Tetta C, Mariano F，et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis：the peak concentration hypothesis[J]．Artif Organs，2015，27(9)：792-801.
3	杨荣利，陈秀凯，王小亭，等．重症血液净化：从连续肾脏替代治疗到集成技术[J]．中华医学杂志2013，93(35)：2769-2771.
4	Kidney disease：improving global outcomes(KDIGO) acute kidney injury work group[J]. Kidney Inte，2012，2：1-138.
5	Karvellas CJ, Farhat MR, Sajjad I，et al.A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis [J]．Crit Care，2011，15(1)：R72.
6	秦凤丽，刘忠民. 连续肾脏替代治疗在急危重症中的应用进展[J]. 内科急危重症杂志，2014，20(6)：418-421.
7	Yan SB, Helterbrand JD, Hartman DL，et al.Low level of protein C are associated with poor outcome in severe sepisi [J]．Chest，2001，120(3)：915-922.
8	Levi M．Disseminate dintrav ascular coagulation[J]．Crit Care Med，2007，35(9): 2191-2195.
9	赵德龙，孙雪峰．维持性血液透析患者肝素诱导血小板减少症的研究进展[J]．中国血液净化，2013，12(11)：625-627.
10	杨德淑，杨平，张艳，等．不同抗凝方案在严重脓毒血症血小板减少患者CRRT中的应用[J]．重庆医学，2014，43(28)：3724-3726.

组别	性别[例(%)]		年龄(岁，±s)	基础病[例(%)]			评分(±s)
组别	男	女	年龄(岁，±s)	冠心病	高血压病	糖尿病	SOFA	APACHEⅡ	Marshall
CRRT组	64(61.9)	39(38.1)	60.8±16.1	2(1.9)	11(10.48)	4(3.81)	11.8±2.6	24.0±7.8	7.2±2.6
常规治疗组	49(56.2)	38(43.8)	63.1±18.3	6(6.7)	16(17.98)	6(6.74)	11.1±3.3	23.1±8.3	7.0±3.0
χ²/t值	0.65		0.21	2.85	2.26	0.85	－1.70	－0.78	－0.56
P值	>0.05		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	性别[例(%)]		年龄(岁，±s)	基础病[例(%)]			评分(±s)
组别	男	女	年龄(岁，±s)	冠心病	高血压病	糖尿病	SOFA	APACHEⅡ	Marshall
CRRT组	64(61.9)	39(38.1)	60.8±16.1	2(1.9)	11(10.48)	4(3.81)	11.8±2.6	24.0±7.8	7.2±2.6
常规治疗组	49(56.2)	38(43.8)	63.1±18.3	6(6.7)	16(17.98)	6(6.74)	11.1±3.3	23.1±8.3	7.0±3.0
χ²/t值	0.65		0.21	2.85	2.26	0.85	－1.70	－0.78	－0.56
P值	>0.05		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	性别[例(%)]		年龄(岁，±s)	基础病[例(%)]			评分(±s)
组别	男	女	年龄(岁，±s)	高血压病	糖尿病	冠心病	SOFA	APACHEⅡ	Marshall
CRRT亚组	11(55.0)	9(45.0)	58.0±19.7	2(10.0)	2(10.0)	0(0.0)	10.0±2.8	20.5±6.4	5.7±2.3
常规治疗亚组	13(44.8)	16(55.2)	57.3±18.8	4(13.8)	2(6.9)	2(6.9)	10.1±3.2	21.9±8.2	6.9±3.2
χ²/t值		0.49	－0.07	0.16	0.15	1.44	－0.63	－1.35	－0.02
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	性别[例(%)]		年龄(岁，±s)	基础病[例(%)]			评分(±s)
组别	男	女	年龄(岁，±s)	高血压病	糖尿病	冠心病	SOFA	APACHEⅡ	Marshall
CRRT亚组	11(55.0)	9(45.0)	58.0±19.7	2(10.0)	2(10.0)	0(0.0)	10.0±2.8	20.5±6.4	5.7±2.3
常规治疗亚组	13(44.8)	16(55.2)	57.3±18.8	4(13.8)	2(6.9)	2(6.9)	10.1±3.2	21.9±8.2	6.9±3.2
χ²/t值		0.49	－0.07	0.16	0.15	1.44	－0.63	－1.35	－0.02
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	Marshall评分		t1值	P1值	APACHEⅡ评分		t1值	P1值	SOFA评分		t1值	P1值
组别	治疗前	治疗后	t1值	P1值	治疗前	治疗后	t1值	P1值	治疗前	治疗后	t1值	P1值
常规治疗组	7.2±2.6	6.7±2.8^a	－2.94	<0.05	24.0±7.8	19.7±7.5^a	－6.86	<0.05	11.8±2.6	10.7±3.1^a	－4.50	<0.05
CRRT组	7.0±3.0	7.2±3.0	－1.37	>0.05	23.1±8.3	23.0±8.5	－0.31	>0.05	11.0±3.2	11.1±3.4	－0.40	>0.05
t值	－3.22				－5.59				－1.70
P值	<0.05				<0.05				>0.05

Please choose a citation manager

Content to export