Evaluation of the efficacy of extracorporeal blood purification in abdominal septic shock: a prospective interventional controlled study

Introduction. The choice of extracorporeal blood purification (EBP) tactics for septic shock (SS) complicated by acute kidney injury (AKI) remains an unresolved clinical problem.

The objective was to evaluate the effectiveness of various EBP approaches in SS management.

Materials and methods. Three groups were included in the study: group 1 (n = 34) received conservative therapy and hemodiafiltration (CVVHDF) for urgent indications; group 2 (n = 35) received early isolated CVVHDF; group 3 (n = 32) received early combined EBP (selective plasmapheresis with CVVHDF). We conducted a comparative analysis of clinical and laboratory parameters.

Results. Application of early combined EBP as part of intensive therapy by day 3 provided a significantly better stabilization of mean arterial pressure – in 37.7% of cases (p = 0.001) – compared to isolated EBP in the early (18.3%, p = 0.042) and delayed periods (12.8%, p = 0.016); reduced organ dysfunction severity (p = 0.002) compared to day 5 outcomes with early isolated EBP (p = 0.021). ICU and hospital stays were 10.5 (6.7; 15) and 21 (18; 25) days respectively, versus 15 (9.5; 20) and 24 (17.5; 27.5) days for early isolated EBP (p = 0.054 and p = 0.267), and 21 (13.2; 26) and 27.5 (22; 41) days for delayed EBP (p = 0.001 for both). Mortality was 28.1% in the combined group versus 42.9% for early isolated EBP (p = 0.112) and 58.7% for delayed EBP (p = 0.012).

Conclusions. Combined EBP as part of intensive therapy enables faster hemodynamic stabilization, improves patients’ clinical status, and leads to better disease outcomes.

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