Safety and efficacy of regional citrate anticoagulation in continuous blood purification treatment of patients with multiple organ dysfunction syndrome.

B Tuerdi,L Zuo,G Li,Z Wang,K Wang,H Sun

doi:10.1590/1414-431x20176378

Abstract

The aim of this study was to discuss the safety and efficacy of regional citrate anticoagulation (RCA) on continuous blood purification (CBP) during the treatment of multiple organ dysfunction syndrome (MODS). Thirty-five patients with MODS were divided into two groups: the local citrate anticoagulation (RCA) group, and the heparin-free blood purification (hfBP) group. The MODS severity was assessed according to Marshall’s MODS score criteria. Blood coagulation indicators, blood pressure, filter lifespan, filter replacement frequency, anticoagulation indicators, and main metabolic and electrolyte indicators were analyzed and compared between RCA and hfBP groups. RCA resulted in lower blood pressure than hfBP. The filter efficacy in RCA treatment was longer than in the hfBP group. The blood clearance of creatine, blood urea nitrogen and uric acid was better in the RCA group. RCA also led to higher pH than hfBP. Neither treatment resulted in severe bleeding events. In addition, MODS score was positively correlated with prothrombin time and activated partial thromboplastin time but negatively correlated with platelet concentration. RCA is a safer and more effective method in CBP treatment; however, it could also lead to low blood pressure and blood alkalosis.

Highlights

Multiple organ dysfunction syndrome (MODS) is a common critical illness, referring to the occurrence of simultaneous or sequential organ or system dysfunction 24 h after severe infection, wound shock, major surgery, severe pancreatitis, cardio-pulmonary resuscitation or other protopathies [1]
Clinical characteristics of participants at the initiation of blood purification Generally, there were no notable differences in the tested indicators between the regional citrate anticoagulation (RCA) and heparin-free blood purification (hfBP) groups (Table 1)
Except for transmembrane pressure (TMP), the remaining tested indicators were significantly higher in the hfBP group than in the RCA group

Summary

Introduction

Multiple organ dysfunction syndrome (MODS) is a common critical illness, referring to the occurrence of simultaneous or sequential organ or system dysfunction 24 h after severe infection, wound shock, major surgery, severe pancreatitis, cardio-pulmonary resuscitation or other protopathies [1]. CBP has already been applied in nonkidney disease treatments and has shown unique advantages when treating severe acute pancreatitis, systemic inflammatory response syndrome, sepsis, acute respiratory distress syndrome and MODS, becoming the main measure used to rescue critically ill patients [5]. CBP is characterized by its hemodynamic stability, high metabolites clearance rate, efficiency of inflammatory mediator elimination and provision of nutritional support [6]. CBP has been widely applied to salvage and treat severely ill patients with remarkable therapeutic efficacy. CBP has been extensively applied in intensive care units in China, and its use on MODS treatment has been fully acknowledged [7]. The disseminated intravascular coagulation, triggered by severe wounds, infection, sepsis and shock, needs to be controlled [8]. Over-anticoagulation may result in bleeding, or even life-threatening problems [9]

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