Timing of continuous veno-venous hemofiltration for patients with wasp sting-induced multiple organ dysfunction syndrome of different phases according to RIFLE criteria

Abstract

Objective To analyze the efficacy of continuous veno-venous hemofiltration(CVVH) for patients with wasp sting-induced multiple organ dysfunction syndrome(MODS)at different phases according to RIFLE criteria.Methods The clinical data of 61 patients with wasp sting-induced MODS,who were treated in Chengdu General Hospital,Southwest Hospital and Xinqiao Hospital during Jan.2006 to Dec.2010,were retrospectively analyzed.Sixteen patients who were not treated with CVVH were taken as controls.Another 45 patients with acute kidney injury(AKI) were divided into 3 groups: group A(AKI Ⅰ),group B(AKI Ⅱ) and group C(AKI Ⅲ)according to the RIFLE criteria;the timing of CVVH was analyzed according to different phases of AKI.The mortality rate in hospital,length of ICU stay,duration of total mechanical ventilation,length of CVVH,and the intervals between wasp sting and CVVH were compared among different groups.Their APACHE Ⅱ scores,sequential organ failure assessment(SOFA) scores,serum interleukin-6(IL-6),oxygenate index,serum creatinine(Cr),and mean arterial pressure(MAP) were compared before and 24 h after CVVH.Results(1)The mortality rate in the control group was significantly higher than that in therapeutic group(P0.01).(2)Before CVVH,APACHE Ⅱ score,SOFA score,serum IL-6,the mortality rate and the interval between wasp sting and CVVH were significantly higher or longer in group C compared with those in group A and B(P0.05).(3)The APACHE Ⅱ score,SOFA score and the mortality rate of group A and B were similar before CVVH(P0.05),but serum IL-6 in group B was significantly higher than that in group A(P0.05).The length of ICU stay,duration of total mechanical ventilation,duration of CVVH and the interval between wasp sting and CVVH in group B were significantly longer than those in group A(P0.01).(4)After 24 h CVVH,the serum IL-6,oxygenate index,Cr and MAP were significantly improved in all the 3 groups(P0.01),but the serum IL-6 in group C was still significantly higher than those in group A and B(P0.05).The APACHE Ⅱ score and SOFA score were significantly decreased in group A and B after 24 h CVVH,but they had no significant change in group C(P0.05).Conclusion CVVH is an effective treatment for patients with wasp sting-induced MODS.RIFLE criteria can help to guide the timing of CVVH.CVVH can remarkably improve the prognosis of patients with phaseⅠand Ⅱ AKI after wasp sting-induced MODS,with the best efficacy seen in patient with phase Ⅰ AKI.