Haemostatic changes in systemic inflammatory response syndrome during continuous renal replacement therapy

Background. Endothelial damage and hemostatic imbalance play an important r ole in the evolution of the Systemic Inflammatory Response Syndrome (SIRS) into the Multiple Organ Dysfunction Syndrome (MODS), In Acute Renal Failure associated with SIRS, different types of Continuous Renal Replacement Ther apies (CRRT) may give non-renal benefits by modifying the levels of some fa ctors related to those disturbances. Methods. Forty patients with SIRS-associated ARF were randomised to receive either continuous venovenous hemofiltration (CVVH) or continuous venovenou s hemodiafiltration (CVVHDF) for the first 24 h, Afterwards the CRRT method was reversed. The group treated with CVVH moved to CVVHDF and that treated with CVVHDF to CVVH for the next 24 h, Plasma levels of: von Willebrand Fa ctor (VWF), thrombomodulin, plasminogen activity inhibitor type 1 (PAI-1: a ntigen and activity), tissue type plasminogen activator (t-PA: antigen), pr othrombin fragment 1+2 (F1+2) and thrombin-antithrombin complexes (TAT) wer e measured previously to CRRT (base-line), and after 24 and 48 hours of the rapy Multivariate ANOVA was the statistical method used. Results. In the MANOVA study a significant decrease in PAI-1 activity durin g the treatment procedure was observed (horizontality p <0.05). PAI-1 antig en showed a tendency to decrease although without statististical significan ce, There were no significantly different changes in the other factors anal ysed during either CRRT (parallelism p >0.05). At the base-line point, all the factors were higher than normal values in healthy adults, Conclusions. The present study suggests that CRRT, in patients with SIRS, m ay promote a decrease in PAI-1 and consequently a better outcome. There wer e no differences between the CVVH and the CVVHDF methods regarding the fact ors analysed. The present data confirms that there is an important endothel ial and hemostatic dysfunction iu SIRS from the early phases.