CYTOKINES IN PLASMA AND ULTRAFILTRATE DURING CONTINUOUS ARTERIOVENOUSHEMOFILTRATION

Cytokines are considered to be important mediators in the pathophysiol ogy of sepsis and septic shock. We investigated if continuous arteriov enous haemofiltration (CAVH) could be used to remove excessive amounts of the cytokines tumour necrosis factor-alpha (TNFalpha), interleukin (IL)-1alpha and IL-6 from peripheral blood in critically ill patients . Nine septic patients with renal failure were treated with CAVH. Ultr afiltrate and plasma were tested for cytokines by ELISA. All patients had detectable TNFalpha and IL-6 plasma levels, ranging from 10-750 pg /ml and 50-4,575 pg/ml, respectively. TNFalpha was removed by the ultr afiltrate with concentrations ranging from 10-1,000 pg/ml. The TNFalph a levels were significantly higher in the ultrafiltrate samples than i n the corresponding plasma samples (P < 0.003). IL-6 was undetectable in the ultrafiltrate from five of the patients despite concomitant hig h plasma levels. IL-1alpha was detectable in both plasma and ultrafilt rate in four patients. All patients developed multi-organ failure and septic shock and seven died. It is concluded that TNFalpha and IL-1alp ha but not IL-6 can be removed by CAVH in patients with sepsis.