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Continuous plasmafiltration in sepsis syndrome. Plasmafiltration in Sepsis Study Group
J H Reeves1, W W Butt, F Shann
1Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia.
Critical Care Medicine
|November 5, 1999
Summary
Plasmafiltration (PF) did not significantly reduce mortality in sepsis patients but did attenuate the acute-phase response. A trend towards fewer organ failures suggests potential benefits, warranting further investigation in sepsis treatment.
Area of Science:
- Critical Care Medicine
- Nephrology
- Immunology
Background:
- Sepsis is a life-threatening condition characterized by a dysregulated host response to infection.
- Inflammatory markers and organ dysfunction are key indicators of sepsis severity and patient outcomes.
- Plasmafiltration (PF) is a technique that removes plasma components, potentially modulating inflammatory processes.
Purpose of the Study:
- To evaluate the impact of plasmafiltration (PF) on biochemical markers of inflammation, cytokine levels, organ dysfunction, and 14-day mortality in patients with sepsis.
- To assess the efficacy of continuous plasma exchange using a hollow-fiber plasma filter in managing sepsis.
Main Methods:
- A multicenter, prospective, randomized, controlled clinical trial involving 30 sepsis patients (22 adults, 8 children) across seven university-affiliated ICUs.
- Patients received protocol-driven supportive care; 14 patients were randomized to receive 34 hours of continuous plasmafiltration.
- Biochemical markers, including acute-phase proteins, inflammatory mediators, and cytokines, were measured at multiple time points. Organ dysfunction and mortality were assessed using validated scales.
Main Results:
- Plasmafiltration significantly reduced levels of alpha1-antitrypsin, haptoglobin, C-reactive protein, and complement fragment C3 within the first 6 hours.
- No significant differences were observed in 14-day mortality between the PF group (57% survival) and the control group (50% survival).
- The PF group showed a trend towards fewer organ failures (2.57 vs. 2.94), although this was not statistically significant. Age and shock were significant predictors of death.
Conclusions:
- Plasmafiltration effectively attenuated the acute-phase response in sepsis patients.
- While not achieving statistical significance, the observed trend of reduced organ failure suggests a potential therapeutic benefit of PF in sepsis.
- Further research may be warranted to explore the role of PF in improving outcomes for sepsis patients, particularly in specific subgroups or with modified protocols.