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Continuous arteriovenous hemofiltration attenuates polymorphonuclear leukocyte phagocytosis in porcine
1Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA.
Background:
Activation of circulating polymorphonuclear leukocytes (PMN) is a characteristic of systemic inflammation and may contribute to organ malfunction. Continuous arteriovenous hemofiltration (CAVH) has been reported to improve organ malfunction during severe systemic inflammation. This study postulates that the CAVH effects may be linked to alterations in PMN activation.
Methods:
Sixteen pigs that underwent cecal ligation and rupture were randomized to receive CAVH or no CAVH for 24 hours. The PMN phagocytosis of Candida was measured prior to the insult and at 24, 48, and 72 hours. Temperature, total leukocyte count (WBC), hemodynamic, blood gas, microbiologic, and ionized calcium data were also collected.
Results:
All animals developed increased temperature, heart rate, and WBC, and positive blood and peritoneal cultures. Hemodynamic, pulmonary, and ionized calcium changes were not different between the CAVH and no CAVH groups. Phagocytosis of PMN increased in the no CAVH group at 24 hours, but not in the CAVH group. After discontinuing CAVH, phagocytosis increased to the no CAVH rate at 48 and 72 hours.
Conclusions:
Continuous arteriovenous hemofiltration attenuates the upregulation of PMN phagocytosis of Candida; this effect disappears after CAVH is discontinued. Hemofiltration does not affect many other manifestations of sepsis, which implies that these manifestations may not be related to PMN phagocytosis capacity.
Insights
Continuous arteriovenous hemofiltration (CAVH) reduces polymorphonuclear leukocyte (PMN) phagocytosis during sepsis. This effect is temporary, highlighting a potential link between CAVH and immune cell function in systemic inflammation.
Area of Science:
- Critical care medicine
- Immunology
- Nephrology
Background:
- Systemic inflammation involves polymorphonuclear leukocyte (PMN) activation, potentially causing organ dysfunction.
- Continuous arteriovenous hemofiltration (CAVH) may improve organ function in severe inflammation.
- This study investigates if CAVH impacts PMN activation.
Purpose of the Study:
- To determine the effect of CAVH on PMN activation during sepsis.
- To explore the relationship between CAVH, PMN phagocytosis, and sepsis manifestations.
Main Methods:
- A sepsis model was induced in 16 pigs via cecal ligation and rupture.
- Animals were randomized to receive either CAVH or no CAVH for 24 hours.
- Polymorphonuclear leukocyte (PMN) phagocytosis of Candida was measured, along with other physiological parameters.
Main Results:
- CAVH attenuated the upregulation of PMN phagocytosis of Candida observed in the control group.
- Phagocytic capacity returned to control levels after CAVH discontinuation.
- No significant differences were found in hemodynamic, pulmonary, or ionized calcium levels between groups.
Conclusions:
- Continuous arteriovenous hemofiltration (CAVH) temporarily reduces PMN phagocytosis capacity during sepsis.
- The observed effect on PMN phagocytosis is reversible upon cessation of CAVH.
- Certain sepsis manifestations may not be directly linked to PMN phagocytosis capacity.