TNF-alpha depuration is a predictor of mortality in critically ill patients under continuous veno-venous hemodiafiltration treatment

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dc.contributor.author Quinto, Beata Marie R. [UNIFESP]
dc.contributor.author Iizuka, Ilson J.
dc.contributor.author Monte, Julio C. M. [UNIFESP]
dc.contributor.author Santos, Bento F.
dc.contributor.author Pereira, Virgilio
dc.contributor.author Durao, Marcelino S. [UNIFESP]
dc.contributor.author Dalboni, Maria Aparecida [UNIFESP]
dc.contributor.author Cendoroglo, Miguel [UNIFESP]
dc.contributor.author Santos, Oscar F. P. [UNIFESP]
dc.contributor.author Batista, Marcelo C. [UNIFESP]
dc.date.accessioned 2016-01-24T14:39:59Z
dc.date.available 2016-01-24T14:39:59Z
dc.date.issued 2015-02-01
dc.identifier http://dx.doi.org/10.1016/j.cyto.2014.10.024
dc.identifier.citation Cytokine. London: Academic Press Ltd- Elsevier B.V., v. 71, n. 2, p. 255-260, 2015.
dc.identifier.issn 1043-4666
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/38692
dc.description.abstract Introduction: Critically ill patients with acute kidney injury (AKI) present high mortality rates. the magnitude of inflammatory response could determine the prognosis of such patients. Continuous renal replacement therapy (CRRT) may play an important role in removing inflammatory mediators in patients with AKI.Aim: To investigate whether the magnitude of inflammatory mediator's removal is associated with mortality among critically ill patients on CVVHDF, a CRRT modality.Methods: This study consisted of 64 critically ill patients requiring CVVHDF. Plasma levels of C3a, TNF-alpha, IL-10, IL-6, IL-1 beta, sTNFRI and sTNFRII were determined by enzyme-linked immunosorbent assay (ELISA) at the beginning of CVVHDF and after 24 h (outlet). Clearance of cytokines during the first 24 h of CVVHDF was calculated. Clinical and laboratory data were acquired from patient's records data.Results: Mean age of patients requiring CVVHDF was 63 years, 67.2% were men and 87.3% were Caucasian. Thirty-five (35) patients (54.7%) died. Comparing non-survivors with the group of survivors we observed higher incidence of sepsis (68.6 versus 37.9%, p < 0.05), higher APACHE II score (34.8 +/- 7.6 versus 29.2 +/- 7.1, p < 0.05) and higher lactate levels (23.2 +/- 17.6 versus 16.4 +/- 6.6, p < 0.05). According to the inter-tertile range of TNF-alpha clearance (ITR1 (<0.54); ITR2 (0.54-2.93); ITR3 (>2.93)) we found that those patients with higher TNF-alpha removal by RRT (ITR3) had a better survival. Multivariable analysis showed that lower clearance of TNF-alpha remained independently associated with high mortality after adjustment for sex, age, use of vasoactive drugs, APACHE II score sepsis, creatinine and lactate before CVVHDF (HR: 0.179, 95% IC: 0.049-0.661, p < 0.01).Conclusion: the attenuation of inflammatory response may be related to the lower mortality observed on those patients with higher TNF-alpha removal by CVVHDF. (C) 2014 Elsevier B.V. All rights reserved. en
dc.description.sponsorship Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.format.extent 255-260
dc.language.iso eng
dc.publisher Elsevier B.V.
dc.relation.ispartof Cytokine
dc.rights Acesso restrito
dc.subject AKI en
dc.subject Inflammation en
dc.subject Cytokines en
dc.subject CVVHDF en
dc.subject Critically ill patients en
dc.title TNF-alpha depuration is a predictor of mortality in critically ill patients under continuous veno-venous hemodiafiltration treatment en
dc.type Artigo
dc.rights.license http://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy
dc.contributor.institution Hosp Israelita Albert Einstein
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Tufts Univ
dc.contributor.institution Univ Uninove
dc.description.affiliation Hosp Israelita Albert Einstein, São Paulo, Brazil
dc.description.affiliation Universidade Federal de São Paulo, Dept Med, Div Nephrol, São Paulo, Brazil
dc.description.affiliation Tufts Univ, Sch Med, Div Nephrol, Medford, MA USA
dc.description.affiliation Univ Uninove, São Paulo, Brazil
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Dept Med, Div Nephrol, São Paulo, Brazil
dc.identifier.doi 10.1016/j.cyto.2014.10.024
dc.description.source Web of Science
dc.identifier.wos WOS:000349063500018



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