The role of extracorporeal blood purification in correcting intoxication markers in septic shock: a prospective interventional controlled study

Introduction . The use of extracorporeal blood purification (EBP) in septic shock (SS) complicated by acute kidney injury (AKI) remains a con troversial topic. The objective was to evaluate the effectiveness of EBP methods in patients with abdominal SS complicated by AKI. Materials and methods . Group 1 included 34 patients who received continuous veno-venous hemodiafiltration (CVVHDF) as emergency therapy. Group 2 consisted of 35 patients who underwent early isolated CVVHDF. Group 3 comprised 32 patients who received early combined EBP (selec tive plasma filtration + CVVHDF). Results . Combined EBP from day 1 to day 5 of therapy demonstrated a reduction in C-reactive protein from 223.5 to 140.9 mg/L (p = 0.001; −37.1%) compared to group 2 (219.7 to 179.2 mg/L; p = 0.004; −18.4%) and group 1 (214.5 to 189.3 mg/L; p = 0.772; −11.7%), as well as a decrease in interleukin-6 from 242.8 to 70.3 pg/mL (p = 0.001; −71.1%) vs. group 2 (233.7 to 123.4 pg/mL; p = 0.003; −47.2%) and group 1 (247.4 to 184.3 pg/mL; p = 0.512; −25.5%). Tumor necrosis factor levels decreased from 20.1 to 4.6 pg/mL (p = 0.001; −77.1%) in group 3, while group 2 showed a reduction from 19.4 to 11.9 pg/mL (p = 0.001; −38.7%) and group 1 exhibited minimal change (21.4 to 20.5 pg/mL; p = 0.525; −4.2%). Cystatin-C levels in group 3 decreased from 1.45 to 0.85 µg/mL (p = 0.048; −41.4%), whereas group 2 showed a slight reduction (1.6 to 1.5 µg/mL; p = 0.997; −6.3%) and group 1 demonstrated an increase (1.5 to 1.9 µg/mL; p = 0.027; +22.7%). Conclusions . Combined EBP significantly reduces inflammatory markers and improves kidney function compared to isolated renal replacement therapy, both in the early and delayed periods.