Cytokine Removal by Plasma Exchange with Continuous Hemodiafiltration in Critically Ill Patients

Abstract

The effectiveness of plasma exchange (PE) with continuous hemodiafiltration (CHDF) in the treatment of critically ill patients was evaluated based on changes in cytokine levels. Twenty-six patients with acute hepatic failure were treated with PE (PE group) or PE and CHDF (PE+CHDF group), and the levels of cytokines such as tumor necrosis factor (TNF)-␣, interleukin (IL)-6, and IL-8 were determined before and after treatment. Bilirubin levels were significantly lower after treatment in both the PE and PE+CHDF groups. There were no significant differences in TNF-␣ levels before and after treatment in the PE group, but the TNF-␣ level was significantly lower after treatment in the PE+CHDF group. There were no significant differences in the IL-6 levels before and after treatment in both the PE and PE+CHDF groups. There were no significant differences in IL-8 levels before and after treatment in the PE group, but the IL-8 level was significantly lower after treatment in the PE+CHDF group. PE with CHDF therapy was given to 5 patients with acutely aggravated autoimmune diseases, 2 patients with hemorrhagic shock and encephalopathy syndrome, and 3 patients with thrombotic microangiopathy. The results suggested that PE with CHDF therapy are useful in critically ill patients with suspected hypercytokinemia.

Effectiveness of Combining Plasma Exchange with Plasma Perfusion in Acute Fatty Liver of Pregnancy: A Retrospective Analysis

“…Early PE combined with PP may be beneficial to facilitating hepatic and renal recovery in AFLP patients. Previous experimental and clinical studies have indicated that combining PE with hemodialysis following acute hepatic failure complicated by MODS results in a beneficial outcome in AFLP patients [15,19,20]. Na et al [21] also reported a patient diagnosed with AFLP with postpartum DIC treated, in combination with supportive treatment, with continuous bedside hemofiltration, allowing stabilization of her hemodynamic condition.…”

Severe acute arsine poisoning treated by plasma exchange

“…SAAP patients treated by HD alone either fail to survive or their kidneys take months to recover. The advantages of PE over HD might be the following: PE can non-specifically scavenge exogenous toxins, cytokines and endotoxins, especially those bound to protein (14); but HD removes low molecular weight substances such as BUN and Cr but elevate cytokines (22,23). Another possible reason is that the arsenic is not hemodialysable (7) because it is bound to protein and arsine (arsenic)-hemoglobin-complexes (19,24).…”

“…PE is an extracorporeal technique that removes toxins, metabolites, inflammatory factors and toxic mediators from the plasma (14)(15)(16)(17) and it is hypothesized that removal of these factors can be therapeutic in certain situations. We …”

Effects of hemoperfusion adsorption and/or plasma exchange in treatment of severe viral hepatitis: A comparative study

“…Hemoperfusion adsorption therapy can eliminate endotoxin and cytokine nonspecifically and play an important role in supporting treatment of liver failure [30] . Plasma exchange separated and discarded plasma of liver failure patients to remove the toxic substances (especially those binding with proteins) and compensated with normal fresh frozen plasma to supplement some essential substances such as coagulation factors, albumin, immunoglobin so as to ameliorate the microenvironment of liver and accelerate the liver regeneration and the liver function recovery [31,32] .…”