Continuous renal replacement therapy attenuates endothelial injury biomarkers in pediatric sepsis: a prospective cohort study

Endothelial cell (EC) injury is a critical factor in sepsis-induced organ failure. Continuous renal replacement therapy (CRRT) is used to improve hemodynamically unstable sepsis. We conducted a single-center, prospective, observational cohort study to assess whether CRRT attenuates sepsis-associated with EC injury. Based on whether CRRT was implemented within 24 h after admission, patients were divided into non-CRRT and CRRT groups. Demographic data, clinical features, and laboratory indexes were collected, and blood samples were collected at admission, 24 h and 7 days after PICU admission. The levels of vascular endothelial growth factor [VEGF], serum intercellular adhesion molecule-1 [sICAM-1], serum vascular cell adhesion molecule-1 [sVCAM-1], vimentin [VIM]), tissue plasminogen activator-plasminogen activator inhibitor-1 complex [t-PAIC], and thrombomodulin [TM] were not different between the CRRT and non-CRRT groups at PICU admission. The mixed-effects models revealed a significant decreasing trend in EC injury biomarkers (sICAM-1, sVCAM-1, VEGF, and VIM). Nevertheless, there were no obvious changes in these indicators in the non-CRRT group. In the CRRT group, EC injury indicators correlated with albumin and lactic acid at sepsis diagnosis. Serum VEGF, VIM, TM, and t-PAIC levels, but not sVCAM-1 or sICAM-1, were significantly lower in survivors than in non-survivors. Patients with higher serum VEGF, VIM, TM, and t-PAIC levels were at risk of worsening pediatric sepsis outcomes. CRRT downregulated the serum levels of EC injury indicators. This is the first prospective pediatric study linking CRRT to endothelial recovery, and EC biomarkers may serve as surrogate markers for endothelial recovery during CRRT.