The Effects of Continuous Blood Purification for SIRS/MODS Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background. Continuous veno-venous hemofiltration (CVVH) has aroused great concern in recent years because its effect on clearing inflammatory mediators and its mechanism of clinical effects in the treatment of critical illness has also become a research direction. Objective. To evaluate the efficacy of continuous blood purification for systemic inflammatory response syndrome (SIRS)/multiple organ dysfunction syndrome (MODS) patients. Methods. A systematic review of the literature was undertaken to assess randomized controlled trials on CVVH. Results. 11 RCTs involving a total of 414 patients were included. Compared with the control group, CVVH for SIRS/MODS patients has several advantages including better effects on clearing the plasma inflammatory mediators IL-6 [SMD3d = −0.45, 95%CI, (−0.83, −0.07), SMD7d = −1.07, 95%CI, (−1.52, −0.62)], on plasma TNF-alfa [SMD3d = −0.87, 95%CI, (−1.69, −0.04), SMD7d = −1.42, 95%CI, (−2.49, −0.35)], lower white blood cell (WBC) count [MD = 2.61, 95%CI, (1.49, 3.73)], shorter hospital stays [MD = −7.21 days, 95%CI, (−10.68, −3.74)] and better stability of hemodynamics. However, there is no significant difference in the mortality rate [MODS:RR = 0.62, 95%CI, (0.38, 1.01), SIRS:RR = 0.75, 95%CI, (0.57, 1.08)]. Conclusions. The study showed that CVVH was able to eliminate inflammatory mediators (TNF-alfa, IL-6) in plasma effectively, lower WBC count and shorter hospital stays than conventional therapeutic measures.

Continuous Hemofiltration Reduces Mortality in Severe Acute Pancreatitis: A Meta-Analysis

“…Blood purification could nonspecifically remove the inflammatory mediators with moderate molecular weights such as tumour necrosis factor- α , interleukin (IL)-1 β , IL-6, and IL-8, which can activate and lead to progressively “waterfall-like” chain reaction playing an important role in the pathogenesis of SIRS [ 26 , 27 ]. Moreover, studies also concluded that continuous hemofiltration could decreases the systemic overflow of inflammatory mediators, which helps restoring the balance between body proinflammatory system and anti-inflammatory system [ 28 , 29 ]. Because the uncontrolled cytokines and inflammatory mediators excessively released during the pathological process of SIRS in SAP are considered to be crucial mediators leading to MODS and even death, the above effect of continuous hemofiltration could be effective on the treatment of SAP.…”

Single immunoglobulin and Toll‑interleukin‑1 receptor domain containing molecule protects against severe acute pancreatitis in�vitro by negatively regulating the Toll‑like receptor‑4 signaling pathway: A clinical and experimental study

“…PAAF contributes to the pathogenesis of acute pancreatitis, as it stimulates the synthesis of TNF-α by pancreatic acinar cells and induces macrophage activation ( 19 ). PAAF increases the production of pro-inflammatory cytokines by interfering with pro-inflammatory and anti-inflammatory signaling pathways ( 29 ) involved in the pathogenesis of SIRS and MODS in patients with acute pancreatitis ( 30 ). In addition, the expression of TLR4 in pancreatic tissue was significantly increased in murine models of SAP, compared with control mice receiving normal saline injections ( 31 , 32 ).…”

Intermittent renal replacement therapy in cardiac surgery patients with unstable hemodynamics

“…Неоднократно сообщалось о снижении ИГ во время конвективной терапии по сравнению со стандартным гемодиализом. С помощью гемофильтрации (ГФ) можно эффективно удалять медиаторы из плазмы, добиться снижения выраженности воспалительной реакции, сократить пребывание в стационаре, и лучше стабилизировать гемодинамику по сравнению с другими методами [15]. Изучение влияния элиминации медиаторов воспаления с помощью эфферентных методов стало одним из перспективных научных направлений из-за снижения выраженности клинических эффектов системного воспаления и предотвращения развития ПОН при лечении критических состояний [15].…”