Research

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

Claude Level¹ , Philippe Chauveau², Olivier Guisset³, Marie Cécile Cazin², Catherine Lasseur², Claude Gabinsky³, Stéphane Winnock⁴, Danièle Montaudon⁵, Régis Bedry⁶, Caroline Nouts⁶, Odile Pillet¹, Georges Gbikpi Benissan¹, Jean Claude Favarel-Guarrigues¹ and Yves Castaing¹

¹Département de Réanimation Médicale, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France

²Service de Néphrologie, Hôpital Saint André, Centre Hospitalier Universitaire, Bordeaux, France

³Service de Réanimation Médicale, Hôpital Saint André, Centre Hospitalier Universitaire, Bordeaux, France

⁴Service de Réanimation Chirurgicale, Hôpital Saint André, Centre Hospitalier Universitaire, Bordeaux, France

⁵Laboratoire de Biochimie, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France

⁶Service de Réanimation Polyvalente, Clinique Mutualiste, Pessac, France

author email corresponding author email

Critical Care 2003, 7:R160-R166doi:10.1186/cc2372

Published:	2 October 2003

See related Commentary: http://ccforum.com/content/7/6/415

Abstract

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.