TNF-alpha depuration is a predictor of mortality in critically ill patients under continuous veno-venous hemodiafiltration treatment

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dc.contributor.authorQuinto, Beata Marie R. [UNIFESP]
dc.contributor.authorIizuka, Ilson J.
dc.contributor.authorMonte, Julio C. M. [UNIFESP]
dc.contributor.authorSantos, Bento F.
dc.contributor.authorPereira, Virgilio
dc.contributor.authorDurao, Marcelino S. [UNIFESP]
dc.contributor.authorDalboni, Maria Aparecida [UNIFESP]
dc.contributor.authorCendoroglo, Miguel [UNIFESP]
dc.contributor.authorSantos, Oscar F. P. [UNIFESP]
dc.contributor.authorBatista, Marcelo C. [UNIFESP]
dc.contributor.institutionHosp Israelita Albert Einstein
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionTufts Univ
dc.contributor.institutionUniv Uninove
dc.date.accessioned2016-01-24T14:39:59Z
dc.date.available2016-01-24T14:39:59Z
dc.date.issued2015-02-01
dc.description.abstractIntroduction: Critically ill patients with acute kidney injury (AKI) present high mortality rates. the magnitude of inflammatory response could determine the prognosis of such patients. Continuous renal replacement therapy (CRRT) may play an important role in removing inflammatory mediators in patients with AKI.Aim: To investigate whether the magnitude of inflammatory mediator's removal is associated with mortality among critically ill patients on CVVHDF, a CRRT modality.Methods: This study consisted of 64 critically ill patients requiring CVVHDF. Plasma levels of C3a, TNF-alpha, IL-10, IL-6, IL-1 beta, sTNFRI and sTNFRII were determined by enzyme-linked immunosorbent assay (ELISA) at the beginning of CVVHDF and after 24 h (outlet). Clearance of cytokines during the first 24 h of CVVHDF was calculated. Clinical and laboratory data were acquired from patient's records data.Results: Mean age of patients requiring CVVHDF was 63 years, 67.2% were men and 87.3% were Caucasian. Thirty-five (35) patients (54.7%) died. Comparing non-survivors with the group of survivors we observed higher incidence of sepsis (68.6 versus 37.9%, p < 0.05), higher APACHE II score (34.8 +/- 7.6 versus 29.2 +/- 7.1, p < 0.05) and higher lactate levels (23.2 +/- 17.6 versus 16.4 +/- 6.6, p < 0.05). According to the inter-tertile range of TNF-alpha clearance (ITR1 (<0.54); ITR2 (0.54-2.93); ITR3 (>2.93)) we found that those patients with higher TNF-alpha removal by RRT (ITR3) had a better survival. Multivariable analysis showed that lower clearance of TNF-alpha remained independently associated with high mortality after adjustment for sex, age, use of vasoactive drugs, APACHE II score sepsis, creatinine and lactate before CVVHDF (HR: 0.179, 95% IC: 0.049-0.661, p < 0.01).Conclusion: the attenuation of inflammatory response may be related to the lower mortality observed on those patients with higher TNF-alpha removal by CVVHDF. (C) 2014 Elsevier B.V. All rights reserved.en
dc.description.affiliationHosp Israelita Albert Einstein, São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Dept Med, Div Nephrol, São Paulo, Brazil
dc.description.affiliationTufts Univ, Sch Med, Div Nephrol, Medford, MA USA
dc.description.affiliationUniv Uninove, São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Dept Med, Div Nephrol, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.format.extent255-260
dc.identifierhttp://dx.doi.org/10.1016/j.cyto.2014.10.024
dc.identifier.citationCytokine. London: Academic Press Ltd- Elsevier B.V., v. 71, n. 2, p. 255-260, 2015.
dc.identifier.doi10.1016/j.cyto.2014.10.024
dc.identifier.issn1043-4666
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/38692
dc.identifier.wosWOS:000349063500018
dc.language.isoeng
dc.publisherElsevier B.V.
dc.relation.ispartofCytokine
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.rights.licensehttp://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy
dc.subjectAKIen
dc.subjectInflammationen
dc.subjectCytokinesen
dc.subjectCVVHDFen
dc.subjectCritically ill patientsen
dc.titleTNF-alpha depuration is a predictor of mortality in critically ill patients under continuous veno-venous hemodiafiltration treatmenten
dc.typeinfo:eu-repo/semantics/article
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