Comparison of the Clinical Effectiveness of AN69-oXiris versus AN69-ST Filter in Septic Patients: A Single-Centre Study

Abstract

<b><i>Introduction:</i></b> The clinical effectiveness of AN69-oXiris remains unclear. This study aimed to compare the effects of AN69-oXiris and AN69-ST filters on cytokine levels and clinical improvement in septic patients. <b><i>Methods:</i></b> This prospective observational study recruited septic patients who underwent blood purification in the First Affiliated Hospital of Soochow University between December 2019 and May 2020. Patients were assigned to an AN69-oXiris (oXiris) or AN69-ST (ST) group based on their preferred filter. Patients’ clinical data, cytokine levels, and prognostic indicators were analysed at baseline (T0), 24 h after treatment (T1), and at the end of the treatment (T2). <b><i>Results:</i></b> Forty-four patients participated in this study (22 patients in each group). Participants in both groups showed improvements in mean arterial pressure (MAP) values, oxygenation indices, and urinary output, and decreased vasoactive-inotropic scores (VISs), heart rates, lactic acid levels, and serum creatinine levels after blood purification. Reductions in cytokine levels were observed at T1 in both groups. Improvement the haemodynamic status was higher in the oXiris group than in the ST group at T2 (MAP: 79.0 [76.0, 85.0] vs. 77.0 [72.75, 79.25] mm Hg, <i>p</i> = 0.04; VISs: 9.10 [0.00, 16.69] vs. 19.05 [10.60, 26.33], <i>p</i> = 0.03, respectively). Patients in the oXiris group also had lower cytokine levels than those in the ST group at T1 (tumour necrosis factor-α: 24.55 [16.9, 30.15] vs. 30.15 [23.38, 34.13] pg/mL, <i>p</i> = 0.04; interleukin (IL)-6: 66.63 [46.21, 102.20] vs. 125.48 [79.73, 167.97] pg/mL, <i>p</i> = 0.01; IL-8: 53.59 [35.10, 66.01] vs. 63.60 [45.58, 83.37] pg/mL, <i>p</i> = 0.04; IL-10: 13.50 [10.35, 18.68] vs. 17.15 [13.80, 21.95] pg/mL, <i>p</i> = 0.04, respectively). There were no significant differences between the 2 groups regarding hospital mortality, intensive care unit length of stay (LOS), and hospital LOS. <b><i>Conclusion:</i></b> Blood purification using the AN69-oXiris or AN69-ST filter proved useful for septic patients, which was associated with reduced cytokine levels and improved clinical condition. Patients treated with AN69-oXiris had a more remarkable improvement in haemodynamic status and lower cytokine levels than those treated with AN69-ST filter, but there were no differences in clinical outcomes. Further investigations are needed to prove this finding.

Application of oXiris-continuous hemofiltration adsorption in patients with sepsis and septic shock: A single-centre experience in China

“…The median time from ICU admission to initiation of oXiris treatment was 18 h, somewhat earlier than the 21–46 h in several other studies ( 11 , 37 , 51 ). The ICU mortality rate was also lower than previously reported rates ( 37 ).…”

“…The median time from ICU admission to initiation of oXiris treatment was 18 h, somewhat earlier than the 21–46 h in several other studies ( 11 , 37 , 51 ). The ICU mortality rate was also lower than previously reported rates ( 37 ). A retrospective study showed that patients who were started on oXiris treatment within 3 h of adequate resuscitation had reduced vasopressor use, decreased SOFA scores, and increased MAP compared with those who were started on oXiris after 3 h of adequate resuscitation ( 52 ).…”

“…It not only has high adsorption efficiency for cytokines and circulating endotoxin, but also has good blood compatibility, and can perform CHFA for patients without plasma separation. Recent studies have shown that the use of oXiris in patients with sepsis or septic shock can effectively reduce lactate levels, reduce concentrations of endotoxin and cytokines, optimize hemodynamics, reduce SOFA scores, and improve clinical outcomes ( 8 , 9 , 11 , 36 , 37 ). European Experience recommends oXiris in septic patients with unstable hemodynamic status, with or without AKI ( 38 ).…”

Effect of CRRT with oXiris filter on hemodynamic instability in surgical septic shock with AKI: A pilot randomized controlled trial

“…These results were consistent with several observational studies where improvements in the hemodynamic status were observed in septic shock patients who underwent CRRT with the oXiris filter. 13,14,17,18 Removal of circulating endotoxins and cytokines may potentially improve hemodynamic instability. 10 oXiris treatment was associated with a more rapid decrease in lactate levels, and lower doses of norepinephrine were required to maintain the MAP, suggesting that CRRT by the oXiris filter may improve the hemodynamic status.…”

“…11,12 It can also provide full dialysis treatment similar to an ordinary dialysis filter. 13,14 Although some case reports have demonstrated the benefit of oXiris for septic AKI patients, [15][16][17][18] the impact of oXiris on patient outcomes lacks high-quality evidence. 19,20 We hypothesized that performing continuous renal replacement therapy (CRRT) with AN69-oXiris might decrease cytokines levels, improve the hemodynamic status, and reduce mortality in surgical septic shock patients with concurrent AKI.…”