The Evaluation Of Efficacy And Timing Of CRRT In Sepsis Patients

Objective：The death caused by sepsis especially septic shock in the proportion ofthe total number of deaths is increasing. CRRT has a certain application in sepsis patients.There are still controversial matter with the effectiveness and application timing in sepsispatients. This study aimed to investigate the efficacy and timing of CRRT in sepsispatients, in order to provide a scientific basis for clinical diagnosis and treatment ofpatients with sepsis.Method：112patients diagnosed with sepsis were enrolled in this study, all patientscame from the Itensive Care Unit of Taizhou People’s Hospital from June2011to October2013. Patients were divided into four groups according to the severity of sepsis andtreatment, sepsis with CRRT group (group A, n=27), sepsis without CRRT group (group B,n=26), septic shock with CRRT group (group C, n=29) and septic shock without CRRTgroup (group D, n=30). The general clinical features, infection index, inflammationmarkers, hemodynamics index, liver and kidney function indicators, the length of stay,hospital costs, patient outcomes and mortality rates of patients in the four groups werecompared and analyzed.Results： There was no significant difference between A and B, or C and D groupswith the gender, age, fasting glucose, APACHE II score, level of T and HR.(1)Infection:There was no statistical difference with the infection index between A and B, or C and Dbefore the treatment. The number of WBC and PCT in group A (or C) was significantlower than that in group B (or D) after the treatment for7days.(2)Inflammation markers:There was no statistical difference with the inflammation markers between A and B, C andD before the treatment. The level of CRP, IL-1β and IL-6in group A was significant lowerthan that in group B after the treatment for7days. The level of IL-6and IL-10in group Cwas significant lower than that in group D after the treatment for7days.(3) Blood flowand tissue perfusion: There was no statistical difference with the level of HR and Lacbetween A and B, C and D before the treatment. The level of HR and Lac in group A (or C)was significant lower than that in group B (or D) after the treatment for7days.(4) Liver and kidney function indicators: There was no statistical difference with the liver andkidney function indicators between A and B, C and D before the treatment. The level ofTBIL, SCr and BUN in group B was significant higher than that in group A after thetreatment for7days. And the level of ALT, SCr and AST in group C was significant lowerthan that in group D after the treatment for7days.(5) Hospitalization and outcome: Thelevel of APACHE II score and hospitalization in group A （or C）was lower than that ingroup B (or D).(6) The shortening rate of hospital stay and Lac in group A was statisticallyhigher than that in group C.Conclusion：Compared to traditional treatment, the patients who received CRRT hadbetter efficiency in the improvement of infection, inflammation and tissue perfusion,maintenance of hemodynamic stability, liver and kidney function, and also had a betterprognosis and outcome. Sepsis patients who received CRRT treatment at an early timecould significantly improve the tissue perfusion, shorter the hospital stays, lower themedical costs to those patients who received CRRT when septic shock. So CRRT receivedat an early time was recommended.