Abstract
ObjectiveIn this study, we aimed to analyze the laboratory and clinical results of cytokine hemadsorption as an immunomodulation therapy in ICU patients diagnosed with sepsis or septic shock.MethodsThe levels of procalcitonin (PCT) and C-reactive protein (CRP), determined to be indicators of infection/sepsis, and the levels of interleukins (IL-6, IL-8, and IL-10) and tumor necrosis factor α (TNFα), deemed as indicators of the cytokine storm, were compared among 32 patients before and after the hemadsorption procedure.ResultsThe hemadsorption significantly reduced the levels of IL-6, IL-8, IL-10, TNFα, PCT, CRP, Acute Physiology and Chronic Health Evaluation (APACHE) scores, mortality rate, and Sequential Organ Failure Assessment (SOFA) scores (p<0.05). APACHE scores and the mean predicted mortality rate (PMR) of the non-survivors measured before the procedure was significantly higher than those of survivors (p=0.002 for both). IL-10, APACHE scores, and the mortality rates determined before the hemadsorption procedure were deemed significant parameters to predict the mortality among all ICU patients (p<0.05). IL-10 levels ≤125.3 ng/L, APACHE score >30, and PMR >70.33 were significantly associated with the mortality rates of all patients, indicating that these three parameters determined before the hemadsorption may be good predictors of mortality among ICU patients with sepsis.ConclusionThe progression of sepsis in ICU patients may be prevented with cytokine hemadsorption applied as an immunomodulator therapy.
Highlights
Sepsis is a serious and life-threatening organ dysfunction that results from an altered regulation in the host response against infections
The hemadsorption significantly reduced the levels of IL-6, IL-8, IL-10, tumor necrosis factor α (TNFα), PCT, C-reactive protein (CRP), Acute Physiology and Chronic Health Evaluation (APACHE) scores, mortality rate, and Sequential Organ Failure Assessment (SOFA) scores (p
APACHE scores and the mean predicted mortality rate (PMR) of the non-survivors measured before the procedure was significantly higher than those of survivors (p=0.002 for both)
Summary
Sepsis is a serious and life-threatening organ dysfunction that results from an altered regulation in the host response against infections. In Turkey, the mortality rates related to sepsis and septic shock in ICUs were reported to be 22% and 78%, respectively [3]. Sepsis triggers the stimulation of the factors in the complement system through the secretion of inflammatory cytokines including several interleukins (IL), tumor necrosis factor α (TNFα), and nitric oxide, resulting in a systemic inflammatory response [4]. This secretion of inflammatory cytokines reduces systemic vascular resistance, leading to acute hypotension and hyperlactatemia, and subsequent septic shock [5]. The combination of hypotension with microvascular obstruction leads to severe tissue ischemia, eventually resulting in multiple organ failure [2,4]
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