Abstract
BackgroundHaemoadsorption has been described as an effective way to control increased pro- and anti-inflammatory mediators (“cytokine storm”) in septic shock patients. No prospective or randomised clinical study has yet confirmed these results. However, no study has yet prospectively specifically investigated patients in severe septic shock with sepsis-associated acute kidney injury (SA-AKI). Therefore, we aimed to examine whether haemoadsorption could influence intensive care unit (ICU) and hospital mortality in these patients. Furthermore, we examined the influence of haemoadsorption on length of stay in the ICU and therapeutic support.MethodsRetrospective control group and prospective intervention group design in a tertiary hospital in central Europe (Germany). Intervention was the implementation of haemoadsorption for patients in septic shock with SA-AKI. 76 patients were included in this analysis.ResultsSeverity of illness as depicted by APACHE II was higher in patients treated with haemoadsorption. Risk-adjusted ICU mortality rates (O/E ratios) did not differ significantly between the groups (0.80 vs. 0.83). We observed in patients treated with haemoadsorption a shorter LOS and shorter therapeutic support such as catecholamine dependency and duration of RRT. However, in multivariate analysis (logistic regression for mortality, competing risk for LOS), we found no significant differences between the two groups.ConclusionsThe implementation of haemoadsorption for patients in septic shock with acute renal failure did not lead to a reduction in ICU or hospital mortality rates. Despite univariate analysis delivering some evidence for a shorter duration of ICU-related treatments in the haemoadsorption group, these results did not remain significant in multivariate analysis.Trial registration CytoSorb® registry https://clinicaltrials.gov/ct2/show/NCT02312024. December 9, 2014. Database: https://www.cytosorb-registry.org/ (registration for content acquisition is necessary)
Highlights
Sepsis is a life-threatening organ dysfunction caused by a dysregulated immune response after infection and is one of the worldwide leading causes of death [1, 2]
We decided to utilise haemoadsorption with CytosorbTM in all patients in the aforementioned period with following condition: septic shock with sepsis-associated acute kidney injury in adult patients treated in our intensive care unit (ICU)
In the historic control group, 672 patients with septic shock were treated in our ICU; 164 developed acute renal failure (ARF) and 70 of them were treated with Continuous veno-venous haemodiafiltration (CVVHDF)
Summary
Sepsis is a life-threatening organ dysfunction caused by a dysregulated immune response after infection and is one of the worldwide leading causes of death [1, 2]. Septic shock is associated with higher in-hospital mortality compared to patients that suffer from sepsis alone. A “cytokine storm” causes the worsening of sepsis to septic shock [4]. This hyperinflammatory reaction is induced by the release of endogenous cytokines (IL-1β, IL-6, IL-12, TNF-α), and the exotoxic ones, like pattern-associated molecular patterns (PAMPs) or damageassociated molecular pattern (DAMPs). Haemoadsorption has been described as an effective way to control increased pro- and anti-inflammatory mediators (“cytokine storm”) in septic shock patients. No study has yet prospectively investigated patients in severe septic shock with sepsis-associated acute kidney injury (SA-AKI). We aimed to examine whether haemoadsorption could influence intensive care unit (ICU) and hospital mortality in these patients. We examined the influence of haemoadsorption on length of stay in the ICU and therapeutic support
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
