Inflammatory Markers During Continuous High Cutoff Hemodialysis in Patients with Septic Shock and Acute Kidney Injury
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High cut-off (HCO) continuous veno-venous hemodialysis (CVVHD) is one of the renal replacement therapies which nonselectively removes inflammatory mediators. This study seeks to examine the association between the inflammatory background and the need for catecholamine treatment in hemodynamically instable patients having septic shock and acute kidney injury during HCO-CVVHD. There were 38 patients (F/M; 16/22, mean age 63 ± 16 years) included in the study. The initial content of the cytokines IL-4, IL-12, IL-17, and TNFα, C-reactive protein, and the score of the Sequential Organ Failure Assessment (SOFA) were assessed. The receiver operating characteristic (ROC) plot showed that a combination consisting of IL-17 × SOFA ≤22.3 was a reliable predictive factor of the need for catecholamine treatment during HCO-CVVHD, with 82% sensitivity and 90% specificity, with the area under curve (AUC) of 0.843; p < 0.001. On the other side, SOFA ≤14.0 predicted catecholamine treatment or its discontinuation when started, with both specificity and sensitivity 83% (AUC = 0.899; p < 0.001). In conclusion, the immune system activation, assessed from the initial level of IL-17, and the clinical SOFA evaluation are of practical help in predicting the need for catecholamine treatment or the probability of a reduction thereof in patients on veno-venous hemodialysis due to septic shock.
KeywordsCatecholamine treatment Cytokines Hemodialysis Immune system activation Kidney injury Septic shock
Supported by grant no. 179 from the Ministry of Science and Higher Education in Poland.
Conflicts of Interest
The authors declare no conflicts of interest in relation to this article.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol received approval of the Bioethics Committee of the Military Institute of Medicine in Warsaw, Poland.
Written informed consent was obtained from all individual participants included in the study.
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