Cargando…

Mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure

OBJECTIVES: To measure the mass transfer and clearance of procalcitonin (PCT) in patients with septic shock during continuous venovenous hemofiltration (CVVH), and to assess the mechanisms of elimination of PCT. SETTING: The medical department of intensive care. DESIGN: A prospective, observational...

Descripción completa

Detalles Bibliográficos
Autores principales: Level, Claude, Chauveau, Philippe, Guisset, Olivier, Cazin, Marie Cécile, Lasseur, Catherine, Gabinsky, Claude, Winnock, Stéphane, Montaudon, Danièle, Bedry, Régis, Nouts, Caroline, Pillet, Odile, Benissan, Georges Gbikpi, Favarel-Guarrigues, Jean Claude, Castaing, Yves
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2003
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC374372/
https://www.ncbi.nlm.nih.gov/pubmed/14624691
_version_ 1782121279456804864
author Level, Claude
Chauveau, Philippe
Guisset, Olivier
Cazin, Marie Cécile
Lasseur, Catherine
Gabinsky, Claude
Winnock, Stéphane
Montaudon, Danièle
Bedry, Régis
Nouts, Caroline
Pillet, Odile
Benissan, Georges Gbikpi
Favarel-Guarrigues, Jean Claude
Castaing, Yves
author_facet Level, Claude
Chauveau, Philippe
Guisset, Olivier
Cazin, Marie Cécile
Lasseur, Catherine
Gabinsky, Claude
Winnock, Stéphane
Montaudon, Danièle
Bedry, Régis
Nouts, Caroline
Pillet, Odile
Benissan, Georges Gbikpi
Favarel-Guarrigues, Jean Claude
Castaing, Yves
author_sort Level, Claude
collection PubMed
description OBJECTIVES: To measure the mass transfer and clearance of procalcitonin (PCT) in patients with septic shock during continuous venovenous hemofiltration (CVVH), and to assess the mechanisms of elimination of PCT. SETTING: The medical department of intensive care. DESIGN: A prospective, observational study. PATIENTS: Thirteen critically ill patients with septic shock and oliguric acute renal failure requiring continuous venovenous postdilution hemofiltration with a high-flux membrane (AN69 or polyamide) and a 'conventional' substitution volume (< 2.5 l/hour). MEASUREMENTS AND MAIN RESULTS: PCT was measured with the Lumitest PCT Brahms(® )in the prefilter and postfilter plasma, in the ultrafiltrate at the beginning of CVVH (T0) and 15 min (T15'), 60 min (T60') and 6 hours (T6h) after setup of CVVH, and in the prefilter every 24 hours during 4 days. Mass transfer was determined and the clearance and the sieving coefficient were calculated according to the mass conservation principle. Plasma and ultrafiltrate clearances, respectively, at T15', T60' and T6h were 37 ± 8.6 ml/min (not significant) and 1.8 ± 1.7 ml/min (P < 0.01), 34.7 ± 4.1 ml/min (not significant) and 2.3 ± 1.8 ml/min (P < 0.01), and 31.5 ± 7 ml/min (not significant) and 5 ± 2.3 ml/min (P < 0.01). The sieving coefficient significantly increased from 0.07 at T15' to 0.19 at T6h, with no difference according to the nature of the membrane. PCT plasma levels were not significantly modified during the course of CCVH. CONCLUSIONS: We conclude that PCT is removed from the plasma of patients with septic shock during CCVH. Most of the mass is eliminated by convective flow, but adsorption also contributes to elimination during the first hours of CVVH. The effect of PCT removal with a conventional CVVH substitution fluid rate (<2.5 l/hour) on PCT plasma concentration seems to be limited, and PCT remains a useful diagnostic marker in these septic patients. The impact of high-volume hemofiltration on the PCT clearance, the mass transfer and the plasma concentration should be evaluated in further studies.
format Text
id pubmed-374372
institution National Center for Biotechnology Information
language English
publishDate 2003
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-3743722004-03-25 Mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure Level, Claude Chauveau, Philippe Guisset, Olivier Cazin, Marie Cécile Lasseur, Catherine Gabinsky, Claude Winnock, Stéphane Montaudon, Danièle Bedry, Régis Nouts, Caroline Pillet, Odile Benissan, Georges Gbikpi Favarel-Guarrigues, Jean Claude Castaing, Yves Crit Care Research OBJECTIVES: To measure the mass transfer and clearance of procalcitonin (PCT) in patients with septic shock during continuous venovenous hemofiltration (CVVH), and to assess the mechanisms of elimination of PCT. SETTING: The medical department of intensive care. DESIGN: A prospective, observational study. PATIENTS: Thirteen critically ill patients with septic shock and oliguric acute renal failure requiring continuous venovenous postdilution hemofiltration with a high-flux membrane (AN69 or polyamide) and a 'conventional' substitution volume (< 2.5 l/hour). MEASUREMENTS AND MAIN RESULTS: PCT was measured with the Lumitest PCT Brahms(® )in the prefilter and postfilter plasma, in the ultrafiltrate at the beginning of CVVH (T0) and 15 min (T15'), 60 min (T60') and 6 hours (T6h) after setup of CVVH, and in the prefilter every 24 hours during 4 days. Mass transfer was determined and the clearance and the sieving coefficient were calculated according to the mass conservation principle. Plasma and ultrafiltrate clearances, respectively, at T15', T60' and T6h were 37 ± 8.6 ml/min (not significant) and 1.8 ± 1.7 ml/min (P < 0.01), 34.7 ± 4.1 ml/min (not significant) and 2.3 ± 1.8 ml/min (P < 0.01), and 31.5 ± 7 ml/min (not significant) and 5 ± 2.3 ml/min (P < 0.01). The sieving coefficient significantly increased from 0.07 at T15' to 0.19 at T6h, with no difference according to the nature of the membrane. PCT plasma levels were not significantly modified during the course of CCVH. CONCLUSIONS: We conclude that PCT is removed from the plasma of patients with septic shock during CCVH. Most of the mass is eliminated by convective flow, but adsorption also contributes to elimination during the first hours of CVVH. The effect of PCT removal with a conventional CVVH substitution fluid rate (<2.5 l/hour) on PCT plasma concentration seems to be limited, and PCT remains a useful diagnostic marker in these septic patients. The impact of high-volume hemofiltration on the PCT clearance, the mass transfer and the plasma concentration should be evaluated in further studies. BioMed Central 2003 2003-10-02 /pmc/articles/PMC374372/ /pubmed/14624691 Text en Copyright © 2003 Level et al., licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
spellingShingle Research
Level, Claude
Chauveau, Philippe
Guisset, Olivier
Cazin, Marie Cécile
Lasseur, Catherine
Gabinsky, Claude
Winnock, Stéphane
Montaudon, Danièle
Bedry, Régis
Nouts, Caroline
Pillet, Odile
Benissan, Georges Gbikpi
Favarel-Guarrigues, Jean Claude
Castaing, Yves
Mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure
title Mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure
title_full Mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure
title_fullStr Mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure
title_full_unstemmed Mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure
title_short Mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure
title_sort mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC374372/
https://www.ncbi.nlm.nih.gov/pubmed/14624691
work_keys_str_mv AT levelclaude masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT chauveauphilippe masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT guissetolivier masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT cazinmariececile masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT lasseurcatherine masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT gabinskyclaude masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT winnockstephane masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT montaudondaniele masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT bedryregis masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT noutscaroline masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT pilletodile masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT benissangeorgesgbikpi masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT favarelguarriguesjeanclaude masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure
AT castaingyves masstransferclearanceandplasmaconcentrationofprocalcitoninduringcontinuousvenovenoushemofiltrationinpatientswithsepticshockandacuteoliguricrenalfailure