Abstract
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to an infection; it carries a risk for mortality, considerably exceeding that of a mere infection. Sepsis is the leading cause for acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) in intensive care unit (ICU) patients. Almost every second critically ill patient with sepsis will develop AKI. In septic shock, the dysregulated host response to infectious pathogens leads to a cytokine storm with uncontrolled production and release of humoral proinflammatory mediators that evoke cellular toxicity and promote the development of organ dysfunction and increased mortality. In addition to treating AKI, RRT techniques can be employed for extracorporeal adsorption of inflammatory mediators using specifically developed adsorption membranes, hemoperfusion sorbent cartridges or columns; these techniques are intended to decrease the level and early deleterious effects of circulating proinflammatory cytokines and endotoxins during the first hours and days of septic shock treatment, in order to improve patient outcomes. Several methods and devices, such as high cut-off membranes, the Oxiris®-AN69 membrane, CytoSorb® and HA380 cytokine hemoadsorption, polymyxin B endotoxin adsorption, and plasmapheresis have been examined in small study series or are under evaluation as ways of improving patient outcomes in septic shock. However, to date, the data on actual outcome benefits have remained controversial, as discussed in this review.
Highlights
Septic shock carries a higher mortality risk compared to general sepsis, with observed intensive care unit (ICU), hospital, and one-year mortality rates ranging between 37–47%, 39–56%, and 60%, respectively [4,6,9]
Presence of pathogenic microbes leads to the detection of pathogen-associated molecular patterns (PAMPs) and damage-associated molecular microbes leads to the detection of pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs) that both lead to dysregulated activation of various cells
One prospective study examining 45 patients with sepsis or septic shock and one large retrospective study on 100 patients with septic shock failed to demonstrate a reduction in vasopressor dosing requirements, there was a decrease in serum lactate levels after CytoSorb therapy
Summary
Sepsis is a severe multi-organ syndrome caused by an infection and is associated with increased morbidity and mortality. According to the most recent iteration of the Sepsis-3 criteria, sepsis is defined as a life-threatening organ dysfunction associated with a dysregulated host response to an infection [1]. The most severe form of sepsis, is less common and affects 10–20% of sepsis patients admitted to intensive care units (ICUs), corresponding to an estimated incidence of 20 per 100,000 population [4,9]. Septic shock carries a higher mortality risk compared to general sepsis, with observed ICU, hospital, and one-year mortality rates ranging between 37–47%, 39–56%, and 60%, respectively [4,6,9]
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