Abstract
BackgroundIn the early stage of severe burn, patients often exhibit a high level of inflammatory mediators in blood and are likely to develop sepsis. High-volume haemofiltration (HVHF) can eliminate these inflammatory mediators. We hypothesised that early application of HVHF may be beneficial in reducing sepsis and improving the prognosis of patients with severe burns.MethodsAdults patients with burns ≥ 50% total burn surface area (TBSA) and in whom the sum of deep partial and full-thickness burn areas was ≥ 30% were enrolled in this randomised prospective study, and they were divided into control (41 cases) and HVHF (41 cases) groups. Patients in the control group received standard management for major burns, whereas the HVHF group additionally received HVHF treatment (65 ml/kg/h for 3 consecutive days) within 3 days after burn. The incidence of sepsis and mortality, some laboratory data, levels of inflammatory cytokines in the blood, HLA-DR expression on CD14+ peripheral blood monocytes, the proportion of CD25+Foxp3+ in CD4+ T lymphocytes, and the counts of CD3+, CD4+ and CD8+ T lymphocytes were recorded within 28 days post-burn.ResultsThe incidence of sepsis, septic shock and duration of vasopressor treatment were decreased significantly in the HVHF group. In addition, in the subgroup of patients with burns ≥ 80% TBSA, the 90-day mortality showed significant decreases in the HVHF group. The ratio of arterial oxygen partial pressure to the fraction of inspiration oxygen was improved after HVHF treatment. In the patients who received HVHF treatment, the blood levels of inflammatory cytokines, including tumour necrosis factor-α, interleukin (IL)-1β, IL-6 and IL-8, as well as the blood level of procalcitonin were found to be lower than in the control group. Moreover, higher HLA-DR expression on CD14+ monocytes and a lower proportion of CD25+Foxp3+ in CD4+ T lymphocytes were observed in the patients in the HVHF group.ConclusionsEarly application of HVHF benefits patients with severe burns, especially for those with a greater burn area (≥ 80% TBSA), decreasing the incidence of sepsis and mortality. This effect may be attributed to its early clearance of inflammatory mediators and the recovery of the patient’s immune status.Trial registrationChinese Clinical Trial Register, ChiCTR-TRC-12002616. Registered on 24 October 2012.
Highlights
In the early stage of severe burn, patients often exhibit a high level of inflammatory mediators in blood and are likely to develop sepsis
Patients were excluded for any of the following reasons: (1) admission more than 3 days after burn; (2) patients with sepsis or multiple organ failure (MOF), which was defined as organ failure of at least two of the organs or systems according to the Sequential Organ Failure Assessment (SOFA) score [18]; (3) documented past history of chronic organ system insufficiency, defined as history of heart failure, cirrhosis, chronic lung disease and receiving chronic dialysis, according to evaluation by the Acute Physiology and Chronic Health Evaluation II (APACHE II) score [19]; (4) pregnant women or lactating patients; (5) patients with mental diseases or immune functional defects; and/or (6) patients with poor compliance for whom completion of treatment was found to be difficult
Forty-one patients were excluded for the following reasons: 21 patients were admitted to our burn centre more than 3 days after the burn, 17 patients refused the trial, 1 patient was diagnosed with acquired immunodeficiency syndrome, and 2 patients developed MOF at admission
Summary
In the early stage of severe burn, patients often exhibit a high level of inflammatory mediators in blood and are likely to develop sepsis. We hypothesised that early application of HVHF may be beneficial in reducing sepsis and improving the prognosis of patients with severe burns. Sepsis is a leading cause of death among patients with severe burns, when it is complicated by septic shock or multiple organ dysfunction syndrome (MODS). Once septic shock or MODS occurs, no specific and effective therapeutic measures are available, resulting in a very poor prognosis. Patients with severe burns often exhibit an intense stress response and produce large amounts of inflammatory mediators, which are prone to result in organ damage and immune dysfunction, increasing susceptibility to infections and even causing sepsis [2, 3].
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