Effects of continuous venous-venous hemofiltration on cellular immune function in patients with early severe sepsis

Abstract

Objective To evaluate prospectively the effect of continuous venous-venous hemofiltration (CVVH) on the cellular immune function and clinical scores in patients with early severe sepsis. Methods Seventy-eight patients with early severe sepsis were randomized into control group (32 cases) and CVVH group (46 cases). The patients in the control group were treated with conventional therapy, and the patients in the CVVH group received at least 48 hours CVVH treatment additionally. Peripheral blood were taken from the patients at 0 hours, 24 hours and 48 hours during CVVH. The percentage of T lymphocyte (TC) subsets including CD4+ and CD8+ as well as the ratio of CD4+ /CD8+ were respectively examined by flow cytometry, and the contents of cytokines released into supernatants were also determined by ELISA. The levels of APACHE II and SOFA of patients were observed. Results At 48 h after CVVH treatment, the percentage of CD4+ for (29.60±4.60)% and the ratio of CD4+ /CD8+ for (1.82±0.49)were significantly increased compared with before treatment (P<0.05), and the levels of serum TNF-α for (24.61±4.58) ng/mL, IL-2 for (216.35±35.52) ng/mL and IL-6 for (102.52±20.13) ng/mL were significantly decreased after the treatment (P<0.05). APACHE Ⅱ for (13.1±1.80) and SOFA for (7.6±0.9)scores were also significantly improved compared with before treatment(P<0.05). Compared with the control group, all indices mentioned above were significantly improved at 48 h after treatment in the CVVH group (P< 0.05). Conclusion CVVH can improve the cellular immune function, maintain the balance of T lymphocyte subsets, and decrease the levels of inflammatory cytokines in patients with severe sepsis. Early CVVH can improve significantly patients’ prognosis. Key words: Continuous venous-venous hemofiltration; Sepsis; Cellular immune; Prognosis