Effects of Early Continuous Venovenous Hemofiltration on E-Selectin, Hemodynamic Stability, and Ventilatory Function in Patients with Septic-Shock-Induced Acute Respiratory Distress Syndrome

Meng, Jianbiao; Lai, Zhizhen; Xu, Xinjian; Ji, Chunlian; Hu, Ma-hong; Zhao, Geng

doi:10.1155/2016/7463130

Cited by 17 publications

(16 citation statements)

References 39 publications

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“…Previous study indicated that continuous hemofiltration application can significantly lower the 28-day mortality (38% vs. 71%, P = 0.011) and in-hospital mortality (62% vs. 86%, P = 0.04) in patients with severe burns and acute kidney injury [ 19 ]. However, the 72-h early-initiated continuous hemofiltration treatment has no effect on the 28-day mortality in patients with septic-shock-induced acute respiratory distress syndrome (ARDS) without acute kidney injury [ 20 ]. Our previous study indicated that continuous hemofiltration improved the inflammatory biomarkers but no advantage in mortality in patients with secondary hemophagocytic syndrome [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Continuous hemofiltration improves the prognosis of bacterial sepsis complicated by liver dysfunction in children

et al. 2018

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BackgroundLiver dysfunction is an independent risk factor for poor prognosis of patients with sepsis. The aim of this study is to evaluate the effects of continuous hemofiltration in patients with bacterial sepsis complicated by liver dysfunction.MethodsWe retrospectively analyzed the medical records of 27 cases of bacterial sepsis with liver dysfunction admitted to pediatric intensive care unit (PICU) of Shanghai Children’s Hospital between January 2013 and December 2016.Results28-day mortality and length of PICU stay were significantly reduced in the continuous hemofiltration group (n = 16) compared with the conventional management group (n = 11) (31.3% vs. 72.7%, 9 [4–23] vs. 14 [4–36], respectively, both P < 0.05). The interval time between PICU admission and continuous hemofiltration initiation was (22.06 ± 17.68) h, and the median time of continuous hemofiltration duration was 48 h (31–70 h). After 72 h hemofiltration, the levels of total bilirubin (TBIL), direct bilirubin (DBIL), total bile acids (TBA), ammonia, lactate (Lac), TNF-α and IL-6 were significantly decreased in the continuous hemofiltration group. Moreover, multivariate logistic regression analysis indicated that continuous hemofiltration treatment and the TBIL level were independently associated with 28-day mortality of patients with bacterial sepsis complicated by liver dysfunction.ConclusionsContinuous hemofiltration significantly decreases the serum levels of TBIL, DBIL, TBA, Lac, ammonia, TNF-α, IL-6, and improves 28-day mortality of patients with bacterial sepsis complicated by liver dysfunction.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1243-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Continuous hemofiltration improves the prognosis of bacterial sepsis complicated by liver dysfunction in children

et al. 2018

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“…Duration of treatment varied from 1 to 96 h spread over 1–7 days. Fourteen studies used CVVH [19, 37, 47, 50, 51, 53, 56, 57, 60, 63, 66-69], 17 used endotoxin adsorption [7, 9, 34, 38, 42-46, 48, 52, 55, 58, 59, 64, 65, 70], 3 used nonspecific adsorption [39, 40, 68], 2 used cytokine removal [54, 62], 2 used CPFA [41, 61], 2 used combined CVVH and adsorption [49, 68], and 1 used plasma exchange [36].…”

Section: Resultsmentioning

confidence: 99%

“…Vasopressor requirement was described either as norepinephrine dose [19, 34, 39, 40, 51, 57, 61, 62, 70], SOFA cardiovascular system score [48, 52], dopamine dose [65], or a vasopressor index [38]. A change in vasopressor use was reported in 3 studies using CVVH [19, 51, 57], 6 studies using endotoxin removal devices [34, 38, 48, 52, 65, 70], 2 studies using nonspecific adsorption [39, 40], 1 study using CytoSorb [62], and 1 study using CPFA [61].…”

Section: Resultsmentioning

confidence: 99%

Effect of Extracorporeal Blood Purification on Mortality in Sepsis: A Meta-Analysis and Trial Sequential Analysis

et al. 2020

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Objective: The objective of this study was to conduct a meta-analysis and trial sequential analysis (TSA) of published randomized controlled trials (RCTs) to determine whether mortality benefit exists for extracorporeal blood purification techniques in sepsis. Data Sources: A systematic search on MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for RCTs was performed. Study Selection: RCTs investigating the effect of extracorporeal blood purification device use on mortality among critically ill septic patients were selected. Data Extraction: Mortality was assessed using Mantel-Haenszel models, and I2 was used for heterogeneity. Data are presented as odds ratios (OR); 95% confidence intervals (CIs); p values; I2. Using the control event mortality proportion, we performed a TSA and calculated the required information size using an anticipated intervention effect of a 14% relative reduction in mortality. Data Synthesis: Thirty-nine RCTs were identified, with 2,729 patients. Fourteen studies used hemofiltration (n = 789), 17 used endotoxin adsorption devices (n = 1,363), 3 used nonspecific adsorption (n = 110), 2 were cytokine removal devices (n = 117), 2 used coupled plasma filtration adsorption (CPFA) (n = 207), 2 combined hemofiltration and perfusion (n = 40), and 1 used plasma exchange (n = 106). On conventional meta-analysis, hemofiltration (OR 0.56 [0.40–0.79]; p < 0.001; I2 = 0%), endotoxin removal devices (OR 0.40 [0.23–0.67], p < 0.001; I2 = 71%), and nonspecific adsorption devices (OR 0.32 [0.13–0.82]; p = 0.02; I2 = 23%) were associated with mortality benefit, but not cytokine removal (OR 0.99 [0.07–13.42], p = 0.99; I2 = 64%), CPFA (OR 0.50 [0.10–2.47]; p = 0.40; I2 = 64%), or combined hemofiltration and adsorption (OR 0.71 [0.13–3.79]; p = 0.69; I2 = 0%). TSA however revealed that based on the number of existing patients recruited for RCTs, neither hemofiltration (TSA-adjusted CI 0.29–1.10), endotoxin removal devices (CI 0.05–3.40), nor nonspecific adsorption devices (CI 0.01–14.31) were associated with mortality benefit. Conclusion: There are inadequate data at present to conclude that the use of extracorporeal blood purification techniques in sepsis is beneficial. Further adequately powered RCTs are required to confirm any potential mortality benefit, which may be most evident in patients at greatest risk of death.

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“…Sepsis and acute respiratory distress syndrome (ARDS) are two types of syndromes needing intensive care with multiple characteristics. Both are common and highly lethal and have significant negative effects on survivors [20]. Sepsis-induced ARDS has an estimated incidence of over 40% and is the leading cause of ARDS death [21].…”

Section: Discussionmentioning

confidence: 99%

“…As a complex pathological process, ARDS is regulated by transcription factors as well as miRNA. A miRNA is a small endogenous non-coding RNA molecule that includes approximately [18][19][20][21][22][23][24] nucleotides. It usually complements sites in the 3' untranslated region of the target messenger RNA for inhibiting the expression of post-transcriptional gene [8].…”

Section: Introductionmentioning

confidence: 99%

miR-146b-3p regulates PI3K/AKT signaling pathway in septic mice with acute respiratory distress syndrome

Liu¹,

Zhu²,

Jin³

et al. 2020

Preprint

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Background: This study aimed to explore the effect of miR-146b-3p on acute respiratory distress syndrome in septic mice by regulating PI3K/AKT signaling pathway. Methods: Seventy C57BL/6 mice were divided into normal group ( n = 10) and modeling group ( n = 60, mice for constructing septic mice models with acute respiratory distress syndrome). Model mice were subdivided into model group (without any treatment), negative control (NC) mimic group (injection with miRNA NC), miR-146b-3p mimic group (injection with miR-146b-3p mimic), si-NC group (injection with PI3Kγ siRNA NC), si-PI3Kγ group (injection with PI3Kγ interference sequence), and miR-146b-3p mimic + oe-PI3Kγ group (injection with miR-146b-3p mimic + PI3Kγ overexpression plasmid). Dual-luciferase reporter assay was conducted to determine the target relationship between miR-146b-3p and PI3Kγ. Wet weight/dry weight (W/D) ratio of the left lung was measured. Hematoxylin and eosin stain was used to detect the pathological change of mouse lung. ELISA was employed to measure serum interleukin (IL) -1β and IL-18 levels. miR-146b-3p and PI3Kγ expressions were detected by qRT-PCR. PI3Kγ, AKT, NLRP3, apoptosis-associated speck-like protein caspase recruitment domain (ASC) and Caspase-1 protein expressions were detected by Western blotting. Results: miR-146b-3p negatively regulated PI3Kγ. The lung tissues in other groups compared with normal group had down-regulated miR-146b-3p, up-regulated PI3Kγ, p-AKT, ASC, NLRP3 and Caspase-1 proteins, higher W/D ratio, and more serum IL-1β and IL-18 (all P < 0.05). All indicators in miR-146b-3p mimic group and si-PI3Kγ group were significantly improved as compared to model group (all P < 0.05). Up-regulated PI3Kγ, p-AKT, ASC, NLRP3 and Caspase-1 proteins and higher W/D ratio and IL-1β and IL-18 levels in serum existed in miR-146b-3p mimic + oe-PI3Kγ group compared with miR-146b-3p mimic group (all P < 0.05). Conclusions: Up-regulation of miR-146b-3p can restrain PI3K/AKT signaling pathway, thereby improving acute respiratory distress syndrome in septic mice.

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Effects of Early Continuous Venovenous Hemofiltration on E-Selectin, Hemodynamic Stability, and Ventilatory Function in Patients with Septic-Shock-Induced Acute Respiratory Distress Syndrome

Cited by 17 publications

References 39 publications

Continuous hemofiltration improves the prognosis of bacterial sepsis complicated by liver dysfunction in children

Continuous hemofiltration improves the prognosis of bacterial sepsis complicated by liver dysfunction in children

Effect of Extracorporeal Blood Purification on Mortality in Sepsis: A Meta-Analysis and Trial Sequential Analysis

miR-146b-3p regulates PI3K/AKT signaling pathway in septic mice with acute respiratory distress syndrome

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