Safety evaluation of regional citrate anticoagulant in continuous renal replacement therapy for patients with hepatic dysfunction

doi:10.3877/cma.j.issn.2096-1537.2020.027

Abstract

Abstract:

Objective

To evaluate the safety of regional citrate anticoagulantion used during CRRT in patients with hepatic dysfunction.

Methods

The clinical data of 56 patients who received regional citrate anticoagulantion during CRRT in ICU of General Hospital of Eastern Theater Command (Qinhuai Medical District) were retrospectively analyzed. Patients were divided into Group Normal liver function, Group Child-Pugh Grade A&B, and Group Child-Pugh Grade C. Anticoagulant effect and adverse effects were observed during the period of treatment. Liver function, coagulation function, acid-base disorders, electrolytes including total calcium and calcium ratio were recorded.

Results

The average duration of treatment in three groups were similar (P>0.05). There was no significant difference of acid-base disorders, electrolytes among three groups except total calcium (P>0.05). In Group Child-Pugh Grade A&B, and Group Child-Pugh Grade C, liver function and coagulation function were similar before and after the CRRT treatment, but proportion of calcium ratio was more than 2.4 in a few patients in two Groups (P<0.05).

Conclusion

The average duration of treatment among three groups are similar. Regional citrate anticoagulantion for CRRT has litter or no influence on acid-base disorders, electrolytes, organ function and coagulation status in patients with liver dysfunction. Only a few patients have citrate accumulation, but no serious complications occurred, indicating that RCA during CRRT is a safe scheme in patients with liver dysfunction.

Key words: Hepatic dysfunction, CRRT, Regional citrate anticoagulantion, Retrospective analysis

Chuyao Zhou, Rong Sun. Safety evaluation of regional citrate anticoagulant in continuous renal replacement therapy for patients with hepatic dysfunction[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(01): 86-91.

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References 17

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组别	例数	年龄（岁）	男性比例［例（%）］	APACHEⅡ评分	SOFA评分
肝功能正常组	20	56.95±20.41	10（50.0）	16.85±3.20	10.42±1.54
肝功能轻中度异常组	20	57.10±15.16	13（65.0）	17.55±4.85	13.00±2.91
肝功能重度异常组	16	52.00±16.54	9（56.3）	17.88±2.36	13.00±2.45
P值		0.629	0.629	0.554	0.001

组别	例数	年龄（岁）	男性比例［例（%）］	APACHEⅡ评分	SOFA评分
肝功能正常组	20	56.95±20.41	10（50.0）	16.85±3.20	10.42±1.54
肝功能轻中度异常组	20	57.10±15.16	13（65.0）	17.55±4.85	13.00±2.91
肝功能重度异常组	16	52.00±16.54	9（56.3）	17.88±2.36	13.00±2.45
P值		0.629	0.629	0.554	0.001

组别	例数	滤器使用时间（h，±s）	使用时间<24 h ［例（%）］
肝功能正常组	20	49.40±16.07	0（0）
肝功能轻中度异常组	20	44.25±15.02	0（0）
肝功能重度异常组	16	41.75±14.90	1（6.25）
P值		0.314	-

组别	例数	滤器使用时间（h，±s）	使用时间<24 h ［例（%）］
肝功能正常组	20	49.40±16.07	0（0）
肝功能轻中度异常组	20	44.25±15.02	0（0）
肝功能重度异常组	16	41.75±14.90	1（6.25）
P值		0.314	-

实验室指标	时间	肝功能正常组（20例）	肝功能轻中度异常组（20例）	肝功能重度异常组（16例）
TB（μmol/L）	T₁	22.60（18.30，26.75）	38.50（32.93，63.08）	339.70（178.83，448.75）
TB（μmol/L）	T₂	23.25（19.15，29.10）	50.10（35.25，89.30）	338.25（151.07，437.77）
DB（μmol/L）	T₁	10.50（9.45，12.33）	24.50（17.80，36.23）	233.90（137.00，340.40）
DB（μmol/L）	T₂	10.65（9.18，13.10）	28.90（18.53，46.35）	248.40（117.72，324.82）
ALT（U/L）	T₁	40.00（25.25，66.25）	29.50（21.25，62.00）	74.00（40.00，103.25）
ALT（U/L）	T₂	44.00（30.50，68.25）	33.50（21.50，74.00）	52.00（42.00，117.50）
Cr（μmol/L）	T₁	252.00（199.50，341.75）	288.50（224.50，369.00）	297.50（260.50，370.00）
Cr（μmol/L）	T₂	162.00（138.00，209.75）	163.00（133.75，201.00）^a	167.50（140.50，204.75）^a
PT（s）	T₁	15.20（13.83，16.65）	15.35（12.73，18.25）	22.15（18.43，27.10）
PT（s）	T₂	14.50（14.10，15.90）	16.20（12.00，23.63）	21.20（17.52，27.12）
PTA（s）	T₁	58.50（47.80，74.15）	46.05（30.95，71.30）	35.20（25.55，45.60）
PTA（s）	T₂	65.50（52.80，70.40）	45.65（28.70，78.77）	33.45（26.10，47.57）
FIB（g/L）	T₁	2.76（2.10，4.05）	2.14（0.94，3.10）	1.31（0.98，2.01）
FIB（g/L）	T₂	2.29（2.01，3.68）	1.67（1.01，3.03）	1.37（0.95，1.99）
APTT（s）	T₁	39.05（35.33，41.75）	47.80（42.50，53.20）	48.45（43.64，55.55）
APTT（s）	T₂	36.90（35.15，39.93）	46.25（37.27，56.30）	49.65（43.42，54.75）

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