Effects of intermittent high-volume hemofiltration in the treatment of patients with severe sepsis and septic shock

Abstract

To investigate the effects of intermittent high-volume hemofiltration (IHVHF) on 28-day survival in severe sepsis and septic shock patients. A retrospective cohort study was conducted. Basic data, IHVHF treatment modality and related information during IHVHF treatment of patients with severe sepsis or septic shock receiving IHVHF because of acute renal failure or multiple organ failure (MOF) were collected. Cox proportional hazard model was used to analyze the risk factors of the patients' 28-day mortality after IHVHF treatment. Totally 44 patients were enrolled, the patients were divided into the high dose group (≥70 ml×kg(-1)×h(-1), n=17) and the low dose group (<70 ml×kg(-1)×h(-1), n=27) according to the mean dose of IHVHF performed. Except for the significant differences of body mass index between the high dose group and the low dose group (20.7±3.2 kg/m(2) vs. 25.3±3.0 kg/m(2), P<0.01), there were no significant differences in basic data and IHVHF treatment method. In 44 patients 17 died within 28 days. The observed 28-day mortality of patients were significantly lower than the predicted mortality [38.6% vs. (61.8±21.9)%, P<0.01]. The mortality rate was significantly lower in the high dose group than in the low dose group [11.8% (2/17) vs. 55.6% (15/27), P=0.004]. Multivariable Cox proportional hazard model analysis showed that the high the sequential organ failure assessment (SOFA) score before IHVHF was associated with increased risk of 28-day mortality [relative risk (RR)=1.279, 95% confidence interval (95%CI)1.127 - 1.452, P<0.001], and high dose IHVHF (RR=0.149, 95%CI 0.032 - 0.694, P=0.015), total hours of IHVHF (RR=0.981, 95%CI 0.966 - 0.997, P=0.016) were associated with decreased risk of 28-day mortality. For patients with severe sepsis and septic shock and complicated by acute renal failure or MOF, high dose IHVHF (≥ 70 ml×kg(-1)×h(-1)) was a protective factor against 28-day mortality for these patients, and prolongation of IHVHF treatment could decrease 28-day mortality.