Objective: To review retrospectively the effect of continuous blood purification (CBP) on septic shock with acute renal failure and respiratory failure as a result of severe pneumonia, and to analyze its relationship with prognosis.
Methods: Twenty-five patients diagnosed as severe pneumonia with varying degrees of multiple organ failure (MOF), septic shock and anuria, were allocated into three groups based on outcome of the patients A (7 patients), died of progressive worsening of septic shock, (9 patients, yet died of severe pneumonia afterwards). Laboratory data and critical scored of the patients 1 day before and 24, 48, and 72 hours after the initiation of CBP were compared among the three groups.
Results: (1) The survival rate in group A was 28%, while the combined fatality in groups B and C was 72%. (2) CBP was forced to be stopped in group B patients within less than 48 hours from the start of treatment. Single-factor analysis suggested: group B exhibited higher level of blood sugar compared with group A [(13.17+/-5.84) mmol/L vs. (8.07+/-2.28) mmol/L, P<0.05], and higher fibrinogen levels compared with group C[(5.75+/-3.08) g/L vs. (3.10+/-1.06) g/L, P<0.05] before the treatment. Forty-eight hours after the initiation of CBP, patients in group B exhibited higher fibrinogen and dopamine levels compared with those of groups A and C [(8.24+/-3.57) g/L vs. (5.13+/-0.94) g/L, (3.01+/-1.22) g/L, P<0.05 and (12.00+/-6.93) microgxkg(-1)xmin(-1) vs. (1.00+/-2.45) microgxkg(-1)xmin(-1), (2.89+/-4.37) microgxkg(-1)xmin(-1), P<0.05, respectively]. (3) Acute physiology and chronic health evaluation III (APACHE III) score of group A before treatment was significantly lower than those in groups B and C (89.43+/-11.28 vs. 108.00+/-15.10 and 104.67+/-13.77, both P<0.05). After 72 hours of CBP treatment, patients in groups A and C showed significantly different changed in APACHE II scores compared with group B (-10.43+/-4.89, -9.11+/-3.76 vs. -2.33+/-4.39, P<0.05) and APACHE III scores (-2.14+/-2.19, -1.00+/-1.87 vs. 0.56+/-1.88, P<0.05).
Conclusion: (1) CBP is curative for some patients in septic shock with acute renal failure and respiratory failure as a result of severe pneumonia, with and overall survival rate of 28%. (2) APACHE III score is a sensitive index before and after CBP treatment, and scores of 90-100 may be taken as an indication for CBP. (3) High blood sugar and fibrinogen levels may be potential risk factors, in particular, a high fibrinogen level implies a poor prognosis.