EFFECT OF HEMOFILTRATION ON HEMODYNAMICS AND SYSTEMIC CONCENTRATIONS OF ANAPHYLATOXINS AND CYTOKINES IN HUMAN SEPSIS

Objective: To determine whether hemofiltration (HF) can eliminate cyto kines and complement components and alter systemic hemodynamics in pat ients with severe sepsis. Design: Prospective observation study. Setti ng: Surgical intensive care unit of a university hospital. Patients: 1 6 patients with severe sepsis. Interventions: Continuous zero-balanced HF without dialysis (ultrafiltrate rate 2 1/h) was performed in addit ion to pulmonary artery catheterization, arterial cannulation, and sta ndard intensive care treatment. Measurements and main results: Plasma and ultrafiltrate concentrations of cytokines (the interleukins IL-1 b eta, IL-6, IL-8, and tumor necrosis factor alpha) and of complement co mponents (C3a(desArg), C5a(desArg)) were measured after starting HF (t (0)) and 4 h (t(4)) and 12 h later (t(12)) Hemodynamic variables inclu ding mean arterial pressure (MAP), mean central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, and car diac output were serially determined. During HE cytokine plasma concen trations remained constant. However, C3a(desArg) and C5a(desArg) plasm a concentrations showed a significant decline during 12-h HF (C3a(desA rg): t(0)=676.9+/-99.7 ng/ml vs t(12)=467.8+/-71, p<0.01; C5a(desArg): 26.6+/-4.7 ng/ml vs 17.6+/-6.2, p<0.01). HF resulted in a significant increase over time in systemic vascular resistance (SVR) and MAP (SVR at t(0): 669+/-85 dyne . s/cm(5) vs SVR at t(12): 864+/-75, p<0.01; M AP at t(0): 69.9+/-3.5 mmHg vs MAP at t(12): 82.2+/-3.7, p<0.01). Conc lusions: HF effectively eliminated the anaphylatoxins C3a(desArg) and C5a(desArg) during sepsis. There was also a significant rise in SVR an d MAP during high volume HE Therefore, HF may represent a new modality for removal of anaphylatoxins and may, thereby, deserve clinical test ing in patients with severe sepsis.