Abstract 349: Effects of Continuous Plasma Diafiltration Therapy in Septic Shock With Acute Liver Failure
Background: Plasma diafiltration (PDF) is blood purification therapy in which simple plasma exchange is performed using a selective membrane plasma separator while the dialysate flows outside the hollow fibers. Several studies demonstrated that PDF therapy is one of the most useful blood purification therapies for use in cases of acute liver failure or severe sepsis. However, PDF therapy is very difficult to undergo in septic shock patients with acute liver failure because of unstable hemodynamics. Moreover, it is likely to deteriorate in acute liver failure immediately after PDF therapy. We have experienced that continuous PDF (CPDF) therapy can undergo in unstable patients with acute liver failure. Therefore, we evaluated the effects of CPDF therapy in septic shock patients with acute liver failure.
Hypothesis: We hypothesis that CPDF therapy has beneficial effects for septic shock patients with acute liver failure.
Methods: Nine patients (M/F 7/2, mean age 55 years) with septic shock, who combined acute liver failure, renal failure and respiratory failure, underwent CPDF therapy. The CPDF therapy was undergone for 7 days. Primary outcomes were changes in hemodynamics and inflammatory responses after CPDF therapy, and secondary outcomes were changes in liver functions and SOFA scores at 7 days after therapy and survival rate at 14days after therapy.
Results: In primary outcomes, hemodynamics in all patients improved at one day after CPDF therapy. WBC counts improved (22,634 to 9,893; p<0.05), C-reactive protein levels decreased (11.0 to 2.0 mg/dL; p<0.05), and procalcitonin levels decreased (31.6 to 2.9 ng/mL; p<0.05) at 7days after CPDF therapy.
In secondary outcomes, total bilirubin decreased (8.3 to 3.4 mg/dL; p<0.05) and PT-INR did not decreased (1.22 to 1.19) at 7 days after CPDF therapy. SOFA scores decreased (13.0 to 8.0; p<0.05) at 7 days after CPDF therapy.
All patients recovered and discharged in ICU.
Conclusion: In the present study, CPDF therapy significant improved hemodynamics, inflammatory responses and severity in septic shock patients with acute liver failure.
- © 2013 by American Heart Association, Inc.