Effects of continuous veno-venous hemofiltration on albumin metabolism of patients with systemic inflammatory response syndrome

Abstract

Objective To investigate the effects of continuous veno-venous hemofiltration (CVVH) on albumin metabolism of patients with systemic inflammatory response syndrome (SIRS).Methods The clinical data of 28 patients who were admitted to the Nanjing General Hospital of Nanjing Military Command from December 2010 to Decemer 2011 were retrospectively analyzed.All the patients were divided into the control group (8 patients),the low-volume CVVH group (2 000 ml/h,10 patients),and the high-volume CVVH group (4 000 mL/h,10 patients).Two stable isotopes,[1-13C] phenylalanine and d5-phenylalanine,were simultaneously intravenously infused into all the patients.The peak areas were calculated for segments with the mass to charge ratios of 192,194,197,218,219 by the selected ion mode of the gas chromatography mass spectrometry.The fractional synthesis rate (FSR) and the fractional breakdown rate (FBR) of albumin were calculated by the mathematical model.All data were analyzed using the one-way analysis of variance,LSD test or Dunnett's T3 test.Results The FSRs of albumin were 5.8％±0.9％,5.7％ ± 1.1％ and 5.7％ ± 1.0％ in the control group,the low-volume CVVH group and the high-volume CVVH group before treatment,with no significant difference between the 3 groups (F =0.04,P＞0.05).The FSRs of albumin were 5.9％±0.8％,7.3％±0.9％ and 7.8％± 1.1％ in the control group,the low-volume CVVH group and the high-volume CVVH group after treatment,with significant difference between the 3 groups (F =9.15,P ＜0.05).The FSRs of albumin of the low-volume CVVH group and the highvolume CVVH group were significantly higher than that of the control group (t =3.40,3.96,P ＜ 0.05),while no significant difference was detected between the low-volume CVVH group and the high-volume CVVH group in the FSR of albumin (t =1.02,P ＞ 0.05).The FBRs of albumin were 7.0％ ± 1.2％,6.5％ ± 0.9％ and 7.2％ ±1.2％ in the control group,the low-volume CVVH group and the high-volume CVVH group before treatment,with no significant difference between the 3 groups (F =0.88,P ＞ 0.05).The FBRs of albumin were 6.9％ ± 1.1％,6.2％±0.9％ and 7.4％± 1.0％ in the control group,the low-volume CVVH group and the high-volume CVVH group after treatment.There was no significant difference in the FBR of albumin after treatment between the 3 groups (F =2.82,P ＞ 0.05).Conclusions Simultaneous infusion of multiple isotopes for the detection of FSR and FBR of albumin is effective and feasible to detect the albumin metabolism.CVVH regulates the albumin metabolism in SIRS patients,and it can increase FSR of albumin in SIRS patients,while the FBR of albumin cannot be decreased by CVVH. Key words: Systemic inflammatory response syndrome; Stable isotope; Albumin; Continuous veno-venous hemofiltration