Abstract: 【Abstract】 Objective To investigate the effect of a novel extracorporeal blood purification therapy, coupled plasma filtration adsorption (CPFA), on serum cytokines in multiple organ dysfunction syndromes (MODS) patients with severe infection. Methods This was a prospective, randomized and crossover clinical trial. A total of 7 patients diagnosed as MODS with severe infection were selected in this study. Patients were randomly allocated to both 10h of coupled plasma filtration adsorption plus hemodialysis (CPFA, treatment A) and 10h of high volume hemofiltration (HVHF, treatment B) with a 12h interval in between. The order of treatment A and B was randomly arranged, i.e., patients received treatment A+B or B+A randomly. Serum levels of seven inflammation mediators including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β(IL-1β), interleukin-10 (IL-10), interleukin-1 receptor antagonist (IL-1Ra), soluble tumor necrosis factor receptor 1 and 2 (sTNFR1, sTNFR2) were measured at 0, 5, 10h of each treatment. Results ①CPFA resulted in the decrease of serum TNF-α and the increase of serum IL-1Ra, sTNFR2/TNF-α ratio and IL-1Ra/IL-1βratio (P＜0.05). During HVHF, serum IL-1βdecreased at 5h and increased to baseline value at 10h, and serum IL-1Ra and IL-1Ra/IL-1βratio increased at 5h and then decreased to baseline value at 10h. The changes of serum TNF-α, IL-1Ra, sTNFR2/TNF-α ratio and IL-1Ra/IL-1β ratio were different between treatment A and treatment B (P＜0.05). ②During CPFA, serum TNF-α, L-1β and IL-6 were decreased by 38.95%, 41.76% and 44.39%, respectively, at 0h after flow through the aparatus; the 3 cytokines were decreased by 23.55%, 16.18% and 7.53%, respectively, at 5h. During HVHF, no changes of these cytokines were found between the arterial and venous ends of the hemofiltrator at 0h and 5h, except that serum IL-1β was decreased by 45.52% through the device at 0h. Conclusions CPFA was superior to HVHF in lowering pro-inflammatory mediators and increasing the ratios of anti-inflammatory mediators / pro-inflammatory mediators. Our findings suggest a potential role of CPFA in the treatment of MODS.

Key words: High volume hemofiltration, Multiple organ dysfunction syndromes, Adsorption, Cytokines