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Title: TNF-alpha depuration is a predictor of mortality in critically ill patients under continuous veno-venous hemodiafiltration treatment
Authors: Quinto, Beata Marie R. [UNIFESP]
Iizuka, Ilson J.
Monte, Julio C. M. [UNIFESP]
Santos, Bento F.
Pereira, Virgilio
Durao, Marcelino S. [UNIFESP]
Dalboni, Maria Aparecida [UNIFESP]
Cendoroglo, Miguel [UNIFESP]
Santos, Oscar F. P. [UNIFESP]
Batista, Marcelo C. [UNIFESP]
Hosp Israelita Albert Einstein
Universidade Federal de São Paulo (UNIFESP)
Tufts Univ
Univ Uninove
Keywords: AKI
Critically ill patients
Issue Date: 1-Feb-2015
Publisher: Elsevier B.V.
Citation: Cytokine. London: Academic Press Ltd- Elsevier B.V., v. 71, n. 2, p. 255-260, 2015.
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.
ISSN: 1043-4666
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