Effect of continuous renal replacement therapy on multidimensional serum biomarkers (IL-4, presepsin, NGAL, PD-L1, IL-10, Ang-2, sTM, histones, mtdna, ADM, and suPAR levels) and clinical symptoms in patients with sepsis

Background: To investigate the effects of continuous renal replacement therapy (CRRT) on traditional and novel multi-dimensional serum biomarkers, including inflammatory cytokines, immune regulation markers, endothelial injury markers, cellular damage indicators, and clinical symptoms in patients with sepsis. Methods: Retrospectively, 116 sepsis patients treated with CRRT from March 2019 to June 2024 formed the observation group. Meanwhile, 219 patients receiving conventional treatment were propensity score-matched 1:1, with 116 selected as the control group. Both groups were compared post-treatment for TNF-α, IL-4, CRP, Presepsin, IL-6, NGAL, PD-L1, IL-10, mHLA-DR, Ang-2, sTM, histones, mtDNA, ADM, suPAR, and clinical indicators. Cox regression identified factors influencing 28-day survival. Results: After treatment, the TNF-α, IL-4, CRP, Presepsin, IL-6, NGAL, PD-L1, IL-10, Ang-2, sTM, histones, mtDNA, ADM, and suPAR levels in the observation group were significantly lower than those in the control (p<0.05), while mHLA-DR expression was higher (p<0.05). The Acute Physiology and Chronic Health (APACHE II) score, Sequential Organ Failure Assessment (SOFA), body temperature, heart rate, and respiratory rate (RR) were also lower in the observation group than in the control. Still, the oxygenation index (PaO2/FiO2) and urine output were higher (p<0.05). After 28 days of treatment, the survival rates in the control and observation groups were 65.52% and 81.90%, respectively. After 28 days of treatment, survival rates were 65.52% (control) and 81.90% (observation). COX regression identified septic shock, lactate, elevated IL-4, CRP Presepsin/IL-6/PD-L1/, and Ang2, higher APACHE II/RR, lower PaO2/FiO2, and lack of CRRT as factors adversely affecting 28-day survival. Conclusion: During routine treatment of sepsis patients, CRRT can comprehensively alleviate inflammatory responses, improve immune dysfunction, reduce endothelial and cellular damage, promote the resolution of sepsis-related symptoms, and play a vital role in improving patient prognosis by modulating multiple biomarkers.