Diagnostic microbiology and infectious disease · 2025
Effect of continuous renal replacement therapy on the trend of inflammatory markers of septic patients; retrospective study.
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Moustafa Moustafa, Hassan Wael, Elkhatieb Mohamed, Curly Gerard
Аннотация
INTRODUCTION: CRRT is extensively used to treat sepsis-related AKI. The acute phase reactants CRP and PCT, which are broadly used to guide antimicrobials, are effectively cleared by CRRT. Given its low molecular weight, CRP is predominantly present as a monomer (mCRP) in the blood and is removed by all CRRT modalities. Similarly, PCT is eliminated by convection as well as adsorption. Hence, plasma levels of both biomarkers may decrease after the initiation of CRRT giving a false indication of improvement.
OBJECTIVES: This study was designed to assess the impact of CRRT on WBCs, CRP, and PCT and their reliability in tracking infection and response to antimicrobials.
METHODS: This retrospective study included 28 ICU patients, evenly divided into CRRT and non-CRRT groups. The Patients' demographic data, SOFA score, APACHE II score, vasopressor support, mechanical ventilation, and inflammatory markers were collected.
RESULTS: patients in the two groups did not show any significant difference in the trend of daily WBC count and CRP, apart from a higher WBC count in the CRRT group on the first day only 23.53 ± 7.05 vs 15.71 ± 6.37, P-Value 0.005. While CRP, WBCs and PCT maintained similar values during the first 3 days after CRRT, only CRP levels declined significantly during the period from 3rd to 6th day [154.66 ± 105.48, 72.86 ± 44.16, 57.18 ± 31.65, 58.38 ± 20.68 respectively: P-Values < 0.05].
CONCLUSION: Similar values during the first 48 h after treatment may indicate the very limited effect of the CRRT treatment on these inflammatory markers. We speculate the decline in CRP trend from the 3rd day after CRRT is an indication of improvement rather than a washing out of CRP and PCT. Therefore, we think these markers are valid tools to follow up on sepsis and response to treatment.
OBJECTIVES: This study was designed to assess the impact of CRRT on WBCs, CRP, and PCT and their reliability in tracking infection and response to antimicrobials.
METHODS: This retrospective study included 28 ICU patients, evenly divided into CRRT and non-CRRT groups. The Patients' demographic data, SOFA score, APACHE II score, vasopressor support, mechanical ventilation, and inflammatory markers were collected.
RESULTS: patients in the two groups did not show any significant difference in the trend of daily WBC count and CRP, apart from a higher WBC count in the CRRT group on the first day only 23.53 ± 7.05 vs 15.71 ± 6.37, P-Value 0.005. While CRP, WBCs and PCT maintained similar values during the first 3 days after CRRT, only CRP levels declined significantly during the period from 3rd to 6th day [154.66 ± 105.48, 72.86 ± 44.16, 57.18 ± 31.65, 58.38 ± 20.68 respectively: P-Values < 0.05].
CONCLUSION: Similar values during the first 48 h after treatment may indicate the very limited effect of the CRRT treatment on these inflammatory markers. We speculate the decline in CRP trend from the 3rd day after CRRT is an indication of improvement rather than a washing out of CRP and PCT. Therefore, we think these markers are valid tools to follow up on sepsis and response to treatment.