Objective: To compare the effect and safety of continuous veno-venous hemofiltration (CVVH)+double plasma molecular absorption (DPMA)+hemoperfusion (HP), CVVH+HP, and CVVH+plasma exchange (PE) in treatment of patient with severe wasp stings injury.
Methods: Multicenter, historical cohort study and superiority test were used. From July 2020 to October 2022, patients with wasp sting injury and multiple organ damage admitted to the intensive care units (ICU) of five hospitals were consecutively screened and recruited into the CVVH+DPMA+HP group (intervention group). Propensity score matching was used to establish historical cohorts. Patients with severe wasp sting injury who hospitalized from January 2016 to June 2020 in each ICU were collected and matched 1:1 with the intervention group, and divided into CVVH+HP group and CVVH+PE group according to their actual hemopurification protocols (historical control groups). The primary outcome was the acute physiology and chronic health evaluation II (APACHE II) score on days 3 and 7 after initiation of treatment. Secondary outcomes included complications, length of ICU and hospital stays, and all-cause mortality. Multivariate Cox proportional risk regression was used to analyze the prognosis of patients.
Results: After propensity score matching, 56 patients in intervention group and each of the two historical control groups were matched successfully. There were no significant differences in age, gender, comorbidities, biochemical test indices and critical illness scores among the groups. After treatment, APACHE II score markedly declined in all groups, and the decrease was faster in the intervention group; treatment with DPMA [hazard ratio (HR) = 1.04, 95% confidence interval (95%CI) was 1.02-1.08, P = 0.00], the decreased levels of body temperature (HR = 1.02, 95%CI was 1.00-1.03, P = 0.02), serum creatine kinase (CK; HR = 0.98, 95%CI was 0.96-1.00, P = 0.05) and myoglobin (MYO; HR = 2.88, 95%CI was 1.24-6.69, P = 0.01) were independent risk factors for APACHE II score decline to the target value (15 scores). There were no significant differences in the incidence of bleeding complications, filter or perfusion thrombosis, blood pressure reduction, catheter-related infection and anaphylaxis among the groups.
Conclusions: CVVH+DPMA+HP regimen can significantly reduce the APACHE II score of patients with severe wasp sting injury, and the efficacy is superior to CVVH+HP and CVVH+PE regimens, with safety.