The Effect Of OXiris-CVVH On The Clinical Outcome Of Patients With Septic Shock

Objective To analyze the risk factors of 28 day mortality in septic shock patients.The benefit of oXiris-CVVH in the treatment of septic shock was evaluated by APACHE2 score.28 day mortality,norepinephrine(NE)dosage and days of use,decrease in venous blood lactic acid,72 h cumulative vasopressor index(CVI),72 h vasoactive inotropic score(VIS)between oXiris-CVVH group and control group were compared.Methods This is a retrospective cohort study.104 patients with septic shock receiving blood purification therapies were enrolled from March 12018 to November 30,2019.The experimental group was treated with oXiris-CVVH,the filter used was AN69ST;the control group was treated with CRRT,the filter was AN69.To explore the risk factors of 28 day mortality in septic shock by logistic regression analysis.to verify the presence of clusters of patients that more likely benefit from the blood purification with oXiris membrane among all patients with septic shock treated in the ICU with this filter.The 28 day mortality,NE dosage and days of use,decrease in venous blood lactic acid between oXiris CVVH group and control group were analyzed by stratification.Results After univariate regression,the RR of oXiris-CVVH was 0.224 and APACHE2 RR was 1.155.Multivariate regression analysis showed that oXiris-CVVH treatment could reduce the 28 day mortality of patients with septic shock by 71.8%,and APACHE2 RR was 1.114.The best cut-off value for predicting death at 28 days is 26.The ROC shows an AUC of 0.755(95%CI:0.658–0.853).sensitivity=70.7%,specificity=82.6%.In APACHE2≤26group,The median survival was more than 28 days for the oXiris-CVVH group,and 19 days for the control group(log-rank P: 0.007).The median time to decrease of venous blood lactate below 2 mmol / L in the oXiris-CVVH group was 3 days,while the control group was longer than 5 days(log-rank P:0.026).The median time to decrease of NE requirements to 0 in the oXirisCVVH group was 3 days,compared to 6 days in the control group(log-rank P:0.04).In addition,patients who received oXiris-CVVH had lower VIS at CVI at 72 hour than those who receive conventional CVVH therapy(P:0.023,0.00(0.00,9.10)VS 9.30(4.60,23.30))and(P:0.033,0(0,2)VS 2(1,3)).There was no significant difference in ratio of NE falling below75%、 50% within 72 hours,intubation time,mechanical ventilation time,CRRT time,Length of hospital stay,intensive care unit length of stay between oXiris-CVVH group and control controls.However,in APACHE II >26 groups,the endpoints above shows meaningless.Conclusion oXiris-CVVH treatment may reduce 28 day mortality of patients with septic shock.The higher Apache 2 score,the higher mortality rate of patients with septic shock.Patients with APACHE II ≤ 26 were more likely to benefit from oXiris-CVVH.In APACHE2≤26 group,oXiris-CVVH not only can reduce 28-day mortality,venous blood lactic acid,but also can reduce the NE dosage,72 h CVI and 72 h VIS.