Cytokine adsorption in severe, refractory septic shock

Wendel‐Garcia, Pedro David; Hilty, Matthias P.; Held, Ulrike; Kleinert, Eva-Maria; Maggiorini, Marco

doi:10.1007/s00134-021-06512-0

Cited by 45 publications

(33 citation statements)

References 6 publications

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“…Importantly, patients treated with HP had an increased risk of death. The authors concluded that their results were consonant with recent evidence that suggests avoidance of indiscriminate use of cytokine adsorption outside of investigational trials 38 …”

Section: Discussionsupporting

confidence: 65%

Hemoperfusion and blood purification strategies in patients with COVID‐19: A systematic review

et al. 2021

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Background Coronavirus disease‐19 (COVID‐19) ranges from asymptomatic infection to severe cases requiring admission to the intensive care unit. Together with supportive therapies (ventilation in particular), the suppression of the pro‐inflammatory state has been a hypothesized target. Pharmacological therapies with corticosteroids and interleukin‐6 (IL‐6) receptor antagonists have reduced mortality. The use of extracorporeal cytokine removal, also known as hemoperfusion (HP), could be a promising non‐pharmacological approach to decrease the pro‐inflammatory state in COVID‐19. Methods We conducted a systematic review of PubMed and EMBASE databases in order to summarize the evidence regarding HP therapy in COVID‐19. We included original studies and case series enrolling at least five patients. Results We included 11 articles and describe the characteristics of the populations studied from both clinical and biological perspectives. The methodological quality of the included studies was generally low. Only two studies had a control group, one of which included 101 patients in total. The remaining studies had a range between 10 and 50 patients included. There was large variability in the HP techniques implemented and in clinical and biological outcomes reported. Most studies described decreasing levels of IL‐6 after HP treatment. Conclusion Our review does not support strong conclusions regarding the role of HP in COVID‐19. Considering the very low level of clinical evidence detected, starting HP therapies in COVID‐19 patients does not seem supported outside of clinical trials. Prospective randomized data are needed.

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Section: Discussionsupporting

confidence: 65%

Hemoperfusion and blood purification strategies in patients with COVID‐19: A systematic review

et al. 2021

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“…The treatment targeting inflammatory mediators has become a new target in the treatment of sepsis, and the removal of systemic inflammatory mediators can be accomplished by blood purification therapy ( 3 ). Alleviating or eliminating endotoxin and cytokine storms in the body can be accomplished in various ways, including blood purification, which helps alleviate sepsis, improve patient hemodynamic status, and perhaps improve patient outcomes ( 3 , 24 – 26 ).…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

Ouyang

et al. 2022

Front. Public Health

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oXiris is a new, high-adsorption membrane filter in continuous hemofiltration adsorption to reduce the inflammatory response in sepsis. The investigators retrospectively reviewed patients with sepsis/septic shock who underwent at least one oXiris-treatment from November 2020 to March 2022. The demographic data, baseline levels before treatment, clinical datas, prognosis, and the occurrence of adverse events during treatment were recorded. 90 patients were enrolled in this study. The hemodynamic indices, sequential organ failure assessment score, lactate, inflammatory biomarkers levels were significantly improved at 12 h and 24 h after treatment. Procalcitonin and interleukin-6 reduction post-treatment of oXiris were most pronounced in infection from skin and soft tissue, urinary and abdominal cavity. Logistic regression analysis showed that pre-treatment sequential organ failure assessment score (p = 0.034), percentage decrease in sequential organ failure assessment score (p = 0.004), and age (p = 0.011) were independent risk factors for intensive care unit mortality. In conclusion, oXiris-continuous hemofiltration adsorption may improve hemodynamic indicators, reduce the use of vasoactive drugs, reduce lactate level and infection indicators. Of note, oXiris improve organ function in sepsis, which may result to higher survival rate.

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“…In fact, their removal is a recognized side-effect of UF, and a number of recommendations have been issued to adjust both the loading and maintenance doses [ 8 ], but less is known about the possible effect of the HA-based techniques. Should this effect exist also for them, it could at least partially account for the conflicting results observed in clinical studies involving septic shock patients treated by this approach: actually, although the use of HA has been associated with a decrease of the catecholamine requests and a better outcome in some studies [ 9 , 10 , 11 , 12 , 13 ], these findings have not been confirmed by other investigators [ 14 , 15 , 16 , 17 ], and a recent meta-analysis involving 120 patients treated with HA failed to establish clear positive or detrimental effects [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Hemoadsorption on the Kinetics of Antibacterial and Antifungal Agents

et al. 2022

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The extracorporeal elimination of a pathogen or damage-associated molecular pattern via blood purification techniques is increasingly being used in patients with septic shock and other clinical conditions characterized by a life-threatening inflammatory response. The removal of these substances can be accomoplished by means of ultrafiltration or hemoadsorption. Independently from the blood putification technique used, they could also affect the clearance of antibacterial and antifungal agents with a potentially significant clinical impact. In our review, we describe the basic principles of ultrafiltration and hemoadsorption, the available devices for this latter and the existing experimental and clinical studies; the final paragraph is dedicated to practical considerations that can help clinicians to consider the clearance of antibiotics and antifungals attributable to these techniques to minimize the risk of a iatrogenic underdosage.

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Cytokine adsorption in severe, refractory septic shock

Cited by 45 publications

References 6 publications

Hemoperfusion and blood purification strategies in patients with COVID‐19: A systematic review

Hemoperfusion and blood purification strategies in patients with COVID‐19: A systematic review

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

The Effects of Hemoadsorption on the Kinetics of Antibacterial and Antifungal Agents

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