الفهرس 
SEPSIS & SEPTIC SHOCKOnly 14 pages are availabe for public view
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Abstract
INTRODUCTION: We conducted a prospective observational study from august 2007 to august 2008
to evaluate early continuous veno-venous haemodiafiltration (CVVHDF), in patients with refractory septic
shock and multi-organ failure upon mortality & morbidity in the ICU.
Methods: CVVHDF was implemented at less than 6–12 hours of maximal haemodynamic support.
Metabolic acidosis, serum lactate & serum procalcitonin level (PCT) before & after CVVHDF at day 5
were the monitoring used to evaluate the improvement achieved.40 patients included in the study were
chosen randomly, 20 underwent CVVHDF (group I) & 20 were control group (group II) treated using
traditional guidelines. APACHE II & Delta-SOFA scoring systems were used before & after CVVHDF at
day 5.
RESULTS: Compared to group II, pts of group I had lower mortality (55% vs 70%). Group I patients
showed a non significant delta SOFA (5.95+4.39 vs 6.2+3.3 in group I & II respectively & P=0.66),
regarding APACHE II scores, group I also showed statistically non-significant lower figures than group II
(on admission APACHE II scores were 39.35+10.65 vs 41.85+10 in group I & II respectively & P=0.45)
while on day 5 APACHE II scores were (34.8+10.6 vs 36.1+10.9 in group I & II respectively & P=0.41).
Group I patients showed lower PCT on admission & day 5 than group II patients (on admission PCT level
was 0.64+0.18 vs 0.68+0.17 in group I & II respectively & P=0.5) while day 5 PCT level was (0.51+0.15 vs
0.52+0.17 in group I & II respectively & P=0.83). Indicators of improvement showed statistically significant
difference between survivors & non-survivors regarding Serum lactate level at day 5 (P<0.001), while other
indicators as Fever, Renal profile, WBC count, Metabolic acidosis, Serum lactate level on admission &
Platlets count were statistically insignificant (on admission P-value=0.2, 0.55, 0.45, 0.41, 0.65, 0.55 for
each indicator respectively & on day 5 P-value=0.37, 0.94, 0.71, 0.5, <0.001, 0.88 for each indicator
respectively).
Conclusion: Early CVVHDF may improve the prognosis of sepsis-related multiple organ failure, Failure
to correct metabolic acidosis rapidly during CVVHDF is a strong predictor of mortality as it was more
evident in non-survivors.Continous rising of serum lactate level despite CVVHDF is associated with
increased mortality rate. Of all scoring systems used SOFA maximum, Delta-SOFA and APACHE II day 5
were the most accurate prognostic indicators for mortality .More than 4 organs failure showed 100%
mortality, while less than 4 organs failure showed no mortality in our study.PCT level was higher in nonsurvivors
but with insignificant statistical difference between the 2 groups.