Effects Of Continuous Renal Replacement Therapy On Inflammatory Mediators In Patients With Multiple Organ Dysfunction Syndrome

Background and aim:Multiple organ dysfunction syndrome(MODS) is the leading cause of death in ICU.Nowadays,MODS have characteristics as complexity,difficult to prevent and high mortality,which is a great subject in Emergency Medicine and research focus in the international medical field.Improving early diagnosis and clinical treatment of MODS becomes the urgent matter.Systemic inflammatory response syndrome(SIRS) is an inflammatory state of the whole body without a proven source of infection.It is a medical emergency which is caused by the cytokines dysregulation.Continuous renal replacement therapy(CRRT) is a important morden treatment to severe patients.It is used to treat fluid overload and electrolyte abnormalities.It has been hypothesized that CRRT may remove endotoxin and inflammatory mediators,regulate leukocyte function,blunt the exaggerated inflammatory response and improve clinical outcome.We examine the levels of IL-1β,IL-4,IL-6,IL-10,TNF-α,observe the variation of concentration.Explore the influence and mechanism of CRRT on patients with MODS.Method:Thirty patients with MODS were enrolled from Jan 2007 to Dec 2007,who received CRRT at least 24 hours.The specimens were collected at the beginning and 3,6,12,24 hours after initiation of CRRT,and IL-1β,IL-4,IL-6,IL-10,TNF-αlevels were measured by ELISA.Blood routine,albumin,lipid,partial indexes of coagulation and fibrinolysis,serum urea nitrogen,creatinine and indexes of pulmonary function were tested.The change of the levels of inflammatory mediators and biochemical indexes were compared before and after treatment.Result:Nineteen patients survived after 14 days(63.3%) and 17 patients survived after 28 days(56.7%) during therapy.The clinical oxygenation and hemodynamics were improved after 6 hours.Among these inflammatory mediators,the level of TNF-α,IL-6,IL-10 rose gradually from beginning(462.24±331.03 pg/ml,106.39±90.82 pg/ml,124.51±118.39 pg/ml),and came to peak at 12 hours(887.88±975.46 pg/ml,132.01±118.14 pg/ml,167.01±161.66 pg/ml)(P＜0.05);and the level of IL-1β,IL-4 decreased from initiation of CRRT,but there were no significant different levels of inflammatory mediators in peripheral blood between initiation and the end of CRRT(P＞0.05).The level of IL-6 in the death group was significantly higher than that in the survival group(145.45±14.28 pg/ml vs 106.03±10.86 pg/ml)(P＜0.05),and the level of IL-10 in the death group was significantly lower than that in the survival group(94.93±16.09 pg/ml vs 143.06±12.24 pg/ml )(P＜0.05).Conclusion:CRRT can partly remove the inflammatory mediators,maintain the homeostasis,but no changes were observed on the serum levels of inflammatory mediators between initiation and the end of CRRT.The MODS patients with high IL-6 or low IL-10 appeared to have a poor prognosis.IL-6 and IL-10 can be prognostic factors of MODS patients.