Different Dose Of CVVH Therapy On The Prognosis Of The Patients Wiht Sepsis:a Meta-Analysis

Objective:Systemly evaluating difference doses of CVVH therapy on prognosis of the patients with sepsis to provide reference for the dose of CRRT.Methods:The randomized controlled trials involved in different doses CVVH therapy of patients with sepsis were searched from Pubmed, Embase, the Cochrane Library, CNKI, Wanfang and VIP till April 2015. According to the inclusion criteria and exclusion criteria to select literature.After quality evaluation and extract data, we use Review Manager 5.2 software to analysis the mortality, renal function recovery time and ICU care duration of patients with sepsis recieve different doses of CWH therapy.Results:12 references of randomized controlled study (RCT), a total of 2343 patients was included in the study.The results of meta-analysis show that when the low dose group and high dose group were set to< 35 ml/(kg·h) and ≥35 ml/(kg·h), low dose group would increase mortality (RR=1.07,95%CI= (0.91,1.27), P=0.40), mortality of 14-15 days (RR=1.41,95%CI= (0.80, 2.52), P=0.24), mortality of 14-30 days (RR=1.27,95%CI= (0.99,1.64), P=0.06), mortality of 30-60 days (RR=1.13,95%CI= (0.71,1.79), P=0.60), mortality of 60-90 days (RR=1.00,95%CI=(0.85,1.19), P=0.98).When the low dose group and high dose group were set to< 45 ml/(kg·h) and 45 ml/(kg·h), low dose group would increase mortality (RR=1.24,95%CI= (1.01,1.52), P=0.04), mortality of 28 days (RR=1.74,95%CI= (1.01,2.99), P=0.04), mortality of 60 days (RR=1.08,95%CI= (0.85,1.36), P=0.53), mortality of 28-60 days (RR=1.18,95%CI= (0.95,1.46), P=0.13), mortality of 60-90 days (RR=1.25,95%CI= (0.80,1.97), P=0.32), renal function recovery time (WMD=3.89,95%CI= (2.68,5.09), P<0.01), ICU stay time (WMD=6.41, 95%CI= (5.34,7.47), P<0.01).In the dose more than 50 ml/(kg·h), when the low dose group and high dose group were set to< 70 ml/(kg·h) and≥70 ml/(kg·h), low dose group increase mortality (RR=1.07,95%CI=(0.88,1.31), P=0.48).Conclusion:There was no statistical significance between <35 ml/(kg·h) and ≥35 ml/(kg·h) in mortality; in the comparison of prognosis between <45 ml/(kg·h) and ≥ 45 ml/(kg·h), the highdose group could significantly reduce the kidney function recovery time, ICU stay time and the mortality of 28 days, but it could not reduce the mortality of a longer time; if the dose was more than 50 ml/(kg·h),there was no statistical significance between <70 ml/(kg·h) and ≥70 ml/(kg·h) in mortality.Therefore, the dose of CVVH for sepsis between 45ml/(kg, h) and 70 ml/(kg, h) maybe quite reasonable.