Efficacy and prognostic value of continuous veno-venous hemofiltration combined with CPFA in sepsis-associated acute kidney injury based on perirenal CT imaging features

Objective This study aimed to preliminarily evaluate and compare the efficacy of continuous veno-venous hemofiltration (CVVH) combined with continuous plasma filtration and adsorption (CPFA) versus CVVH monotherapy based on CT imaging features with multidimensional indicators, and to exploratorily analyze the associations between post-treatment indicators and prognosis. Methods This study is a prospective, randomized controlled, single-center clinical trial with efficacy comparison as its primary objective. A total of 70 patients diagnosed with sepsis-associated acute kidney injury (AKI) and treated at the hospital between October 2024 and January 2026 were recruited and subsequently allocated through randomization into control group (conventional treatment + CVVH) and observation group (conventional treatment + CVVH combined with CPFA). The changes in left perirenal computed tomography (CT) features, serum inflammatory cytokines, sublingual microcirculatory parameters, and endothelial injury markers were compared between the two groups at 0 h and 72 h after treatment. Patients were further divided into the survival group (46 cases) and the death group (24 cases) based on 28-day survival outcomes to evaluate prognosis. Results After 72 h of treatment, both groups showed significant improvements from baseline in left perirenal imaging (fascial thickening, fat density, thickness, stripe signs), inflammatory markers [IL-1β, IL-6, IL-10, procalcitonin (PCT), C-reactive protein (CRP)], microcirculatory parameters [perfused vessel density (PVD), proportion of perfused vessels (PPV), microvascular flow index (MFI) increased, heterogeneity index (HI) decreased], and endothelial injury markers [syndecan-1 (SDC-1), soluble intercellular adhesion molecule-1 (sICAM-1)] ( P < 0.05), with significantly greater improvements in the observation group than controls ( P < 0.05). At 72 h, all indicators in the death group were significantly worse than in the survival group ( P < 0.05), and combining multiple indicators offered the best prognostic value. Conclusion The CVVH combined with the CPFA blood purification regimen is associated with a trend toward greater improvement than CVVH alone in reducing perirenal tissue edema, suppressing systemic inflammation, improving microcirculatory perfusion, and protecting vascular endothelial function in patients with sepsis-associated AKI. In addition, the exploratory analysis of this study suggests that combined assessment integrating CT imaging features with multidimensional indicators at 72 h after treatment may be associated with patients' 28-day prognosis, providing a potential direction for future prognostic prediction research.