The effects of continuous blood purification on renal function,inflammatory factors and immune function in patients with sepsis combined with acute kidney injury

Yao Wen; Bai Ming; Li Yajuan; Luo Heng

doi:10.13498/j.cnki.chin.j.ecc.2024.05.09

Abstract：Objective To analyze the impact of continuous blood purification (CBP) on the renal function,inflammatory factors,and immune function in patients with sepsis combined with acute kidney injury,as well as its effects on microcirculation and prognosis. Methods A retrospective analysis was performed on 195 patients with sepsis combined with acute kidney injury who were admitted to the Department of Nephrology at the First Affiliated Hospital of Air Force Medical University from March 2022 to March 2024. 97 patients receieved conventional treatment were included in the routine group,and 98 patients receieved CBP treatment in addition to routine treatment were included in the CBP group. The renal function,inflammatory factors,immune function,microcirculation,and prognosis before treatment and 3 days after treatment in the two groups were compared. Results Comparison of basic data such as age,gender,Acute Physiology and Chronic Health Status Score Ⅱ (APACHE Ⅱ score),AKI classification and primary disease between the two groups did not show any statistically significant difference (P>0.05). After treatment,choline esterase (CHE) increased but serum creatinine (SCr) and blood urea nitrogen (BUN) decreased in both groups. The CBP group showed a higher increase in CHE and a greater decrease in SCr and BUN than the control group (P<0.05);Tumour necrosis factor-α (TNF-α),high-sensitivity C-reactive protein (hs-CRP),procalcitonin (PCT),and interleukin-6 (IL-6) decreased in both groups. The CBP group showed a greater decrease in TNF-α,hs-CRP,PCT,and IL-6 than the control group (P<0.05);CD4+,CD4+/CD8+,and CD3+increased in both groups. with the CBP group showed a higher increase in immune indicators than the control group (P<0.05);The microvascular flow index (MFI) and perfusion vessel ratio (PPV) increased,while the peripheral vascular resistance index (SVRI) decreased in both groups,The CBP group showed a higher increase in MFI and PPV as well as a greater decrease in SVRI compared to the control group (P<0.05);The SOFA and APACHE Ⅱ scores decreased in both groups,The CBP group showed a greater decrease in SOFA and APACHE Ⅱ than the control group (P<0.05). The duration of ICU stay and the time for renal function recovery in the CBP group were significantly shorter than those in the control group,with statistical significance (t=5.449,8.281,P<0.05). There was no statistically significant difference in survival or mortality rates between the two groups (x2=1.241,1.768,P>0.05). The incidence of adverse reactions in the CBP group was lower than the control group (x2=5.130,P<0.05). Conclusion CBP is effective in correcting the inflammatory state,improving renal function and immune function in patients with sepsis combined with acute kidney injury,and it can also restore the body's microcirculatory function,which is beneficial for improving the prognosis.