A Comparison Of Different Initiation Of Continuous Blood Purification In Critically Ill Patients With Severe Sepsis

Objective: For children with severe sepsis, the best time to intervene continuous bloodpurification(CBP) was still controversial.Our aim was to investigate the impact ofdifferent initiation of CBP on clinical outcomes in critically ill patients with severe sepsis.Methods:177children PICU admissions who was diagnosed with severe sepsis andachieve CBP indications during the study period of Feb1st,2012to Dec31th,2013atHunan Children’s Hospital were enrolled in the study. Patients with cancer,congenitalimmunodeficiency,inherited metabolic diseases,liver transplantation or renal transplantai-n and a history of chronic renal insufficiency were excluded.177patients were categoriz-ed into three groups according to the time from admission to agree CBP intervention,thegroup A(≤12h),the group B(>12h) and the contorl group(CBP did not agree tointervene).The indicators inlude K+,Na+,Cl-,Ca2+,pH,base excess(BE),lactic acid(Lac),bl-ood glucose(BG),procalcitonin(PCT),alanine transaminase(ALT),aspartate aminotransfe-rase(AST),blood urea nitrogen(BUN),serum creatinine(Scr),creatine kinase-MB(CK-MB),pediatric critical illness score(PCIS),sepsis-related organ failure assessment(SOFA).Results:1. After7days of treatment pH and BG recovery ratios in group A and group B werehigher than control group (P <0.05);No significant difference in the three groupselectrolytes back to normal proportions(P>0.05); The ΔBE (D7-D1) and ΔLac (D1-D7)in group A was significantly better than group B and control group (P <0.05); The ΔBE(D7-D1) in group B was significantly better than control group (P <0.05); There nosignificant difference in ΔLac (D1-D7) between group B and control group (P>0.05).2. ΔWBC (D1-D7),ΔPCT (D1-D7) and ΔCRP (D1-D7)in group A were higher thancontrol group (P <0.05);ΔPCT (D1-D7) and ΔCRP (D1-D7)in group B were higher than control group (P <0.05); ΔCRP (D1-D7)in group A were higher than group B(P<0.05).3. After7days of treatment BUN and Scr recovery ratios in group A and group B werehigher than control group (P <0.05); ΔALT (D1-D7),ΔAST (D1-D7) and ΔCK-MB(D1-D7) in group A were higher than control group and group B (P <0.05); ΔALT (D1-D7) and ΔAST (D1-D7) in group B were higher than control group (P <0.05);TheVentilator-free days at28day in group A was longer than control group and group B (P<0.05); There no significant difference in Ventilator-free days at28day between group Band control group (P>0.05).4. The PICU length of stay in group A was shorter than control group and group B (P<0.05); There no significant difference in PICU length of stay between group B andcontrol group (P>0.05). No significant difference in the three groups the total length ofhospital stay (P>0.05); Hospital costs in group B was higher than control group (P<0.05); There no significant difference in hospital costs between group A and controlgroup (P>0.05).5. The hospital mortality in group A,group B and contorl group was41.4%、12.1%and31.6%， respectively,the difference among the three groups was significant (χ2=9.350，P=0.009). The28days survival in group A,group B and contorl group was57.5%,87.9%and68.4%,respectively,the difference among the three groups wassignificant(χ2=10.071，P=0.007). The90days survival in group A,group B and contorlgroup was55.2%,87.9%and64.9%,respectively,the difference among the three groupswas significant(χ2=11.173，P=0.004). The hospital mortality in group A was lowerthan control group and group B (P <0.05); The28days survival and90days survival ingroup A was higher than control group and group B (P <0.05); There no significantdifference in hospital mortality,28days survival and90days survival between group Band control group (P>0.05).Conclusion:1.CBP could improve clinical indicators of severe sepsis in children, the advantage is more obvious in the group which involved CBP earlier.2. CBP within12hours to intervene could improve the28days survival and90dayssurvival.