Yin Fan, Zhang Fang, Liu Shijian, Ning Botao
Department of Pediatric Intensive Care Unit, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
Clinical Research Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
Ann Transl Med. 2020 Apr;8(7):488. doi: 10.21037/atm.2020.03.48.
Sepsis remains the leading cause of death in the intensive care unit (ICU), despite the treatment of sepsis has progressed. As a mode in continuous renal replacement therapy (CRRT), continuous veno-venous hemofiltration (CVVH) has been widely used in the treatment of sepsis. Whether high ultrafiltrate volume in CVVH is beneficial for sepsis survival remains controversial. We performed a systematic review and meta-analysis to evaluate the treatment effect of high-volume hemofiltration (HVHF) on sepsis.
A systematic search was conducted on the Medline, Embase, and Cochrane library to June 21, 2019, the keywords included "sepsis" "continuous blood purification" "continuous renal replacement therapy" "continuous veno-venous hemofiltration" and "continuous veno-venous hemodiafiltration". Summery statistic in this review was risk ratio (RR) and was performed by RevMan 5.2.
Five randomized controlled trials (RCT) were included which contained 241 participants. Mortality related endpoints and other observations (length of stay, organ function evaluation, effect on hemodynamics, cytokine clearance and respiratory function) were used to assess the treatment effect of HVHF in sepsis. Three trials reported 28-day mortality, one of three trails also reported 60- and 90-day mortality; one trail did not specify the type of mortality; the fifth article reported hospital mortality. The pooled risk ratio for three trails of 28-day mortality was 0.96 (0.67, 1.38). Three trails reported length of stay related data. Four trails reported organ failure related scores. All trails reported the effect of HVHF on hemodynamics. Three trails reported cytokine clearance. Only two trails reported respiratory function related indicators. After analysis, the risk of bias in all trails was low.
The meta-analysis results suggested that treatment programs contained HVHF did not change the outcomes of patients with sepsis. So far, related studies on the use of HVHF in critically ill patients with sepsis or septic shock is rare. Researchers should consider additional large multicenter randomized controlled trials.
尽管脓毒症的治疗已取得进展，但它仍是重症监护病房（ICU）死亡的主要原因。作为连续性肾替代治疗（CRRT）的一种模式，连续性静脉-静脉血液滤过（CVVH）已广泛应用于脓毒症的治疗。CVVH中的高超滤量对脓毒症患者生存是否有益仍存在争议。我们进行了一项系统评价和荟萃分析，以评估高容量血液滤过（HVHF）对脓毒症的治疗效果。
在Medline、Embase和Cochrane图书馆进行系统检索，截至2019年6月21日，关键词包括“脓毒症”“连续性血液净化”“连续性肾替代治疗”“连续性静脉-静脉血液滤过”和“连续性静脉-静脉血液透析滤过”。本综述的汇总统计量为风险比（RR），采用RevMan 5.2进行分析。
纳入了5项随机对照试验（RCT），共241名参与者。使用与死亡率相关的终点指标和其他观察指标（住院时间、器官功能评估、对血流动力学的影响、细胞因子清除率和呼吸功能）来评估HVHF对脓毒症的治疗效果。3项试验报告了28天死亡率，其中1项试验还报告了60天和90天死亡率；1项试验未明确死亡率类型；第5篇文章报告了医院死亡率。3项试验的28天死亡率合并风险比为0.96（0.67，1.38）。3项试验报告了住院时间相关数据。4项试验报告了器官功能衰竭相关评分。所有试验均报告了HVHF对血流动力学的影响。3项试验报告了细胞因子清除率。只有2项试验报告了呼吸功能相关指标。分析后，所有试验的偏倚风险较低。
荟萃分析结果表明，包含HVHF的治疗方案并未改变脓毒症患者的预后。迄今为止，关于在脓毒症或脓毒性休克重症患者中使用HVHF的相关研究很少。研究人员应考虑开展更多大型多中心随机对照试验。
