Timing Of Continuous Renal Replacement Therapy In Patients With Sepsis And Clinical Outcomes

Background: sepsis is a kind of severe inflammation caused by exogenous microbial invasion with the scope of whole body.It was difficult to control is and lead serious damage to the body.While actively explore and improve the treatment measures,the global mortality is still millions every year,with the arrangement of non cardiac death in second.The body after continuous renal replacement therapy can achieve the fluid balance,oxygen transport and oxygen balance,anti-inflammatory and proinflammatory balance.The treatment plays an absolutely helpful effect to patients with sepsis,and has become an important means for the treatment of sepsis.But many details of implementation of continuous renal replacement therapy such as the best start time,the appropriate reference index,are still in the debate.Objective:To explore the prognosis of different time to start CRRT for patients with sepsis,for clinical selection of CRRT beginning time.Methods: Retrospective analyze of 49 cases of patients with sepsis treating by CRRT,undertake APACHE II、AKIN stage、creatinine clearance rate(Ccr)、Glasgow Coma Scale,(GCS)evaluation before CRRT and 28 day survivorship。Then undertake body temperature(T),heart rate(HR),mean,arterial pressure(MAP),urine volume,white blood cell(WBC)and procalcitonin(PCT),serum creatinine(Scr),creatinine clearance rate(Ccr),urea(BUN),p H,Pa O2(Pa O2)and blood pressure(HCO3-),bicarbonate lactate(Lac),hematocrit(Hct%),platelet count(PLT)before therapy and after therapy in first day、second day、third days、seventh days.According to the APACHE II score,we divide patients into <25 and ≥25 two groups.Compared variance of clinical indicator before and after CRRT,analyzed risk factors influencing prognosis of patients by logistic analysis.Explore the relationship between biochemical indexes and APACHE II scores by ROC curve.Results:After treatment,patients died in 23 cases(47%),26 cases(53%)survived,the treatment after the day 1,3,7,HR,WBC,Ccr,Scr,BUN,p H,Pa O2 PLT before treatment showed obvious different(P < 0.05),and indicators of the APACHE II score < 25 groups outcomes better than APACHE II score≥ 25 groups,which HR,WBC,Scr,Ccr,BUN,Pa O2 between the two groups has statistical significance(P < 0.05).APACHE II score,AKIN stage,different time to start CRRT have no significant difference in groups of 28 day mortality.The,shock,APACHE score and timing of CRRT were independent risk factors2 8 day survival rate.PCT and Scr has better diagnostic value for APACHE score.Conclusions: CRRT have a positive therapeutic effect on the prognosis of sepsis.In the early phase of sepsis,CRRT can improve the physiological indexes of patients.Early CRRT treatment,shock,APACHE II score levels is independent risk factors influencing the 28 day survival rate.28 day mortality in patients with no significant difference in time to different groups of APACHE II score,AKIN stage.