Role of Early Continuous Venovenous Hemodiafilteration in Septic Shock and Multi-Organ Failure
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- Category: Vol. 78, March 2010
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Role of Early Continuous Venovenous Hemodiafilteration in Septic Shock and Multi-Organ Failure,AHMAD A. BATTAH, HOSSAM M. SHERIF and AHMAD H. EL-SHERIF
Abstract
To evaluate early continuous veno-venous haemodiafil-tration (CVVHDF) in patients with refractory septic shock and multi-organ failure upon mortality & morbidity in the ICU. Forty patients were prospectively studied and randomly treated with either conventional treatment (20 patients, group II) or with early CVVHDF (less than 6 hrs of maximal hemo-dynamic support) in addition to the conventional treatment (20 patients, group I). Metabolic acidosis, serum lactate & serum procalcitonin level (PCT) before & 5days after CVVH-DF were monitored to evaluate the outcome. APACHE II & Delta-SOFA scoring systems were used before & 5days after CVVHDF. Compared to group II, pts of group I had lower mortality (55% vs 70%) with insignificant p-value (p=0.54). Group I patients showed a non significant delta SOFA (5.95±4.39 vs 6.2±3.3 in group I & II respectively & p=0.66), regarding APACHE II scores, group I also showed statistically non-significant lower Figs. than group II (on admission APACHE II scores were 39.35±10.65 vs 41.85±10 in group I & II respectively & p=0.45) while on day 5 APACHE II scores were (34.8±10.6 vs 36.1±10.9 in group I & II respec-tively & p=0.41). Group I patients showed lower PCT on admission & day 5 than group II patients (on admission PCT level was 0.64±0.18 vs 0.68±0.17 in group I & II respectively & p=0.5) while day 5 PCT level was (0.51±0.15 vs 0.52±0.17 in group I & II respectively & p=0.83).
Indicators of improvement showed statistically significant difference between survivors & non-survivors in group I regarding Serum lactate level at day 5 (p<0.001), while other indicators as Fever, Renal profile, WBC count, Metabolic acidosis, Serum lactate level on admission & Platelets count were statistically insignificant (on admission p-value =0.2, 0.55, 0.45, 0.41, 0.65, 0.55 for each indicator respectively & on day 5 p-value =0.37, 0.94, 0.71, 0.5, <0.001, 0.88 for each indicator respectively). There was a significant statistical difference between survivors & non-survivors in group I considering number of organs failure as less than or equal to 3 organs involved in comparison to more than 3organs involved (p=0.008).
So we can conclude that early CVVHDF may improve the prognosis of sepsis-related multiple organ failure. Contin-uous rising of serum lactate level despite CVVHDF is asso-ciated with increased mortality rate. Of all scoring systems used SOFA maximum, Delta-SOFA and day 5 APACHE II were the most accurate prognostic indicators for mortality.