Safety and efficacy of heparin free anticoagulant continuous blood purification in treatment of sepsis patients in intensive care unit

Abstract

Objective To investigate the safety and efficacy of heparin free anticoagulant continuous blood purification (CBP) in the treatment of intensive care unit (ICU) sepsis. Methods From October 2015 to October 2017, a total of 80 patients with sepsis treated in ICU with CBP in No.307 Hospital of PLA were included in this study using the random number table. Patients were divided into study group (n=40) and control group (n=40) according to the anticoagulant methods, of which the study group received heparin free anticoagulation, while the control group was given low molecular-weight heparin anticoagulation. The clinical outcome, renal function index and coagulation function were analyzed retrospectively. Paired t test was used to compare acute physiology and chronic health evaluation (APACHE) Ⅲ scores predicted mortality, urea nitrogen level, serum creatinine level, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) between two groups before and after treatment. χ2 test was used in analyzing survival rates in 28 d between two groups after treatment. The procedure of this study is in accordance with the requirements of the revised World Medical Association Declaration of Helsinki in 2013. Informed consent was obtained from all participants. Results ① Before treatment, APACHE Ⅲ scores predicted mortality was (89.6±14.8)% in study group, and was (90.1±13.8)%in control group, and there was no significant difference between two groups (P>0.05). After treatment, 28 d survival rate was 40.0% in study group, and was 47.5% in control group, and there was no significant difference between two groups (P>0.05). ② After treatment, urea nitrogen level was (12.8±1.7) mmol/L, blood creatinine level was (162.5±21.7) μmol/L in study group, and all were significantly lower than those before treatment, which were (22.7±3.8) mmol/L and (276.4±35.8) μmol/L, and the differences were statistically significant (t=8.827, 9.102; P=0.002, 0.000). After treatment, urea nitrogen level was (10.7±2.9) mmol/L, and serum creatinine level was (142.4±37.0) μmol/L in the control group, and all were lower than those before treatment, which were (26.1±3.1) mmol/L, (322.3±38.9)μmol/L respectively, and the differences were statistically significant (t=8.182, 8.992; P=0.006, 0.000). And levels of urea nitrogen and blood creatinine in the 2 groups after treatment were not statistically different (P>0.05). ③ After treatment, platelet count was (67.9±18.7) ×109/L, PT was (19.6±6.7) s, APTT was (28.7±6.1) s and TT was (3.0±1.1) s in study group, and all were significantly lower than those before treatment, which were (117.5±26.8) ×109/L, (28.6±7.9) s, (61.9±15.7) s and (24.2±6.9) s respectively, and the differences were statistically significant (t=7.233, 7.527, 6.232, 7.426; P=0.012, 0.011, 0.037, 0.007). Platelets count was (72.7±16.9) ×109/L, PT was (18.6±6.8) s, APTT was (31.9±7.1) s, and TT was (3.0±1.1) s in the control group, and all were significantly lower than these before the treatment, which were (109.7±25.7) ×109/L, (25.8±6.9) s, (56.7±14.9) s, (24.3±6.9) s respectively, and the differences were statistically significant (t=9.125, 6.728, 6.426, 7.529; P=0.000, 0.029, 0.031, 0.006). Platelet count, PT, APTT and TT levels in the 2 groups after treatment were not statistically different (P>0.05). Conclusions Heparin free and low molecular-weight heparin CBP therapy both can improve the clinical symptoms and renal function index of patients with sepsis in ICU. Heparin free anticoagulation CBP could not lead to abnormal coagulation function and increase platelet consumption, and could improve safety. Key words: Anticoagulant; Heparin, low-molecular-weight; Sepsis; Heparin free anticoagulant; Continuous blood purification