HEMOFILTRATION INCREASES IL-6 CLEARANCE IN EARLY SYSTEMIC INFLAMMATORY RESPONSE SYNDROME BUT DOES NOT ALTER IL-6 AND TNF-ALPHA PLASMA-CONCENTRATIONS

Objective: To test the hypothesis that continuous hemofiltration incre ases interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF alpha) clearances and results in decreased cytokine plasma concentrations ind ependent of renal function in patients with early SIRS. Design: Prospe ctive, controlled, randomized study. Setting: Intensive care units at a university hospital. Patients: 28 consecutive patients who fulfilled the criteria of the systemic inflammatory response syndrome (SIRS). I nterventions: Patients with SIPS were randomly assigned to either a he mofiltration or a control group irrespective of renal function. In pat ients of the hemofiltration group an isovolemic hemofiltration was ini tiated directly after the diagnosis of SIRS and maintained for at leas t 48 h. Measurements and results: A significant (p < 0.001) increase i n total IL-6 clearance (hemofiltrate + urine), but not in TNF alpha cl earance, was observed with hemofiltration. However. the plasma concent rations of both cytokines remained unchanged, Hemodynamic variables di d not change significantly. Conclusions: Continuous hemofiltration inc reases IL-6 plasma clearance but not TNF alpha clearance. However, hem ofiltration failed to decrease plasma concentrations of TNF alpha and IL-6 and, therefore, cannot be used effectively for cytokine eliminati on in SIRS. Accordingly, beneficial effects occasionally reported with hemofiltration are unlikely to be expected due to elimination of IL-6 or TNF alpha.