Selective plasmofiltration in the treatment of patients with abdominal septic shock: a prospective interventional controlled study

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INTRODUCTION: The choice of tactics for the use of extracorporeal detoxification in the form of indications and modality of procedures in patients with abdominal septic shock (SS) remains an unsolved problem. OBJECTIVES: To evaluate the effect of selective plasmofiltration (SPF) as part of complex intensive therapy on the dynamics of markers of systemic inflammatory response syndrome, the severity of the condition and disease outcomes in patients with abdominal SS. MATERIALS AND METHODS: The study included 85 patients with the clinical picture of abdominal SS complicated by acute kidney injury. Group 1 (23 patients) received combined detoxification: SPF and continuous renal replacement therapy (CVVHDF). Group 2 (62 patients) received isolated CVVHDF. A comparative analysis of the main clinical and laboratory parameters and treatment outcomes was performed between the groups. RESULTS: The use of combined detoxification made it possible to reduce markers of systemic endogenous intoxication: C-reactive protein from 225.4 (211; 248.4) to 210.5 (180.39; 230.18) mg/l by the 3rd day of therapy (6.6 %; p = 0.0016), by the 5th–7th–10th days 156.17 (110.67; 180.62), 87 (74.5; 94.1), 62.2 (45.7; 71), respectively (30.7–61.4–72.4 %; p = 0.044; p = 0.0001; p = 0.0001); interleukin-6 demonstrated a decrease of 12.2 % by the 2nd day (p = 0.017) and 35.5, 39.4, 45.7 and 52.4 % by the 3rd–5th–7th–10th days of therapy, respectively (p = 0.022; p = 0.009; p = 0.0018; p = 0.0001); leukocytes from 19.7 (17.7; 22.4) to 17.25 × 109/l (14.65; 19.15) by the 3rd day (12.4 %; p = 0.00045), and 10.9 (9.3; 14.1) by the 10th day (44.7 %; p = 0.00048). Severity of organ dysfunction (SOFA) from 6 (4; 6) on the 1st day to 4 (3; 5) points by the 3rd day of therapy (p = 0.026). A significant difference in survival was obtained (p = 0.037). CONCLUSIONS: Combined detoxification consisting of SPF and CVVHDF allows for rapid normalization of laboratory markers of systemic inflammatory response syndrome and improves patient survival.