Abstract：Objective: To investigate the reference value of serum cystatin C (Cys C) detection on the continuous renal replacement therapy time of the patients with sepsis combined multiple organ dysfunction syndrome (MODS). Methods: 86 cases of sepsis combined with MODS were selected from June 2015 to August 2017 in our hospital with ICU. According to the time intervals between the time point of serum Cys C level began to increase and the time point of continuous renal replacement therapy began, they were divided into group A (<48h, 34 cases), group B (48~72h, 25 cases) and group C (>72h, 27 cases). The changes of 24h vital signs before and after continuous renal replacement therapy were recorded and compared, including heart rate, body temperature, APACHE II score and SOFA score; 48h cardiac index (CI), stroke output index (SVI), mean arterial pressure (MAP) and peripheral vascular resistance index (SVRI) levels were monitored before treatment and after treatment; venous blood and arterial blood samples were taken before treatment and 48h after treatment, the contents of alanine aminotransferase (ALT), total bilirubin (TBIL), blood urea nitrogen (BUN), serum creatinine (Scr), blood lactate and procalcitonin (PCT) were measured. Results: ①Compared with before treatment, the 24h heart rate, body temperature, APACHE II score and SOFA score of the three groups were significantly lower (P<0.05) after continuous renal replacement therapy. Compared with group B and C, the heart rate, body temperature, APACHE II score and SOFA score in group A were significantly decreased (P<0.05). ②Compared with before treatment, the 48h CI, SVI and MAP increased significantly (P<0.05) and SVRI significantly decreased (P<0.05) in the three groups after continuous renal replacement therapy. Compared with group B and C, the increase of CI, SVI and MAP was more significant (P<0.05), and the decrease of SVRI was more significant (P<0.05) in group A. ③Compared with before treatment, ALT, TBIL, BUN, Scr, blood lactic acid and PCT decreased significantly in the three groups at 48h after continuous renal replacement therapy (P<0.05). Compared with group B and C, the decrease of ALT, TBIL, BUN, Scr, blood lactic acid and PCT in group A was more significant (P<0.05). ④The time of continuous renal replacement therapy and the time of ICU hospitalization in group A were significantly less than those in group B (P<0.05); the time of continuous renal replacement therapy and the time of ICU hospitalization in group B were significantly less than those in group C (P<0.05). The 4 weeks mortality rate in group A was lower than that in group B and group C, but the difference was not statistically significant (P>0.05). Conclusion: Continuous renal replacement therapy within 48h of serum Cys C level may better control the condition of septic patients with MODS.
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2018, Vol. 24 
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