Cytokine elimination during continuous hemofiltration. A feasible clinical modality for septic patients

ABSTRACT

Tumour necrosis factor a [TNF-alpha] and interleukin 6 [IL-6] arc important prognostic markers in intensive care unit [ICU] septic patients. The aim of the study was to determine whether continuous venovenous hemofiltration [CVVH]. using Fresenius hemofilter AV600s, leads to elimination of TNF-alpha and IL-6 in 20 septic patients with multi-organ failure. At the start of hemofiltration [o], 6 and 12 hours the mean afferent plasma concentration +/- SD of TNF-alpha [41.9 +/- 9.56, 30.85 +/- 6.2. 25.5 +/- 5.28 pg/ml] and that of IL-6 [890 +/- 183.96, 635 +/- 149.65, 410 +/- 168.27, pg/ml]. 'the different plasma concentrations were significantly lower than tile corresponding afferent concentrations. TNF-alpha and IL-6 were detectable in the ultra filtrate of all patients. The plasma clearance of TNF-alpha and IL-6 significantly decreased after 12 hours as a result of the adsorptive elimination of the mediators due to progressive membrane saturation. We demonstrated that CVVH could represent an appropriate tool to remove a broad spectrum of proinflammatory mediators, if such removal is required in septic patients