Is Procalcitonin Reduction Indicative of Immunomodulation in Septic Patients Treated with Hemodialysis with High Cutoff Membrane?

Villa, Gianluca; Maggio, Paola; Gaudio, Angelo Raffaele De

doi:10.1159/000363496

Cited by 3 publications

(4 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…60 KDa) after blood exposure [ 12 , 13 , 18 ]. This feature is important to achieve clinically relevant clearance of “filterable” toxins, such as inflammatory mediators [ 7 , 19 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

Organ dysfunction during continuous veno-venous high cut-off hemodialysis in patients with septic acute kidney injury: A prospective observational study

et al. 2017

Self Cite

View full text Add to dashboard Cite

BackgroundContinuous veno-venous hemodialysis with high cut-off membranes (HCO-CVVHD) removes inflammatory mediators involved in organ dysfunction during sepsis. The aim of the present study was to assess the variations in SOFA score and identify early predictors of short-term mortality in a cohort of patients with septic shock, treated with HCO-CVVHD for acute kidney injury (AKI).MethodsAn observational prospective multicenter cohort study was conducted in four mixed medical-surgical ICUs. Thirty-eight patients with septic shock and AKI (KDIGO stage≥1) treated with HCO-CVVHD have been included in this study. Patients were divided into Survivors and non-Survivors according to mortality observed at 72nd hr of treatment. The variation of SOFA scores and clinical/biochemical parameters were described over time for the entire population and specifically for Survivors and non-Survivors. Similarly, circulating inflammatory mediators (as IL-6, TNF-a and IL-10) were described over time. A logistic regression analysis was used to identify the baseline clinical and biochemical parameters associated with 72 hrs-ICU mortality.ResultsOverall, the mean SOFA score was 12±3 at baseline, 10.9±3 at 6hrs, 9.8±3 at 12hrs, 8.9±3.3 at 24 hrs, and 8±3.5 at 48 hrs after HCO-CVVHD initiation; and 6.5±2.7 at 24 hrs and 6.6±3 at 48 hrs after HCO-CVVHD discontinuation. In the multivariate regression analysis, baseline serum lactate levels and AKI stage independently correlated with short-term mortality during HCO-CVVHD. A significant reduction was observed in circulating levels of TNFα and IL-6 among Survivors.ConclusionsSOFA score significantly decreased early after initiation of HCO-CVVHD in patients with septic AKI. Baseline lactate levels and the AKI stage resulted to be associated to 72 hrs-ICU-mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Organ dysfunction during continuous veno-venous high cut-off hemodialysis in patients with septic acute kidney injury: A prospective observational study

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…The clinical effects of HCO-CRRT may be particularly evident in this subgroup of patients due to the massive inflammatory burden posed by these infections. As stated above, clinical role of proinflammatory mediators is debated, and clinical improvement may be linked to a significant reduction of high levels of either TNF-α and IL-6, as well as other mediators such as IL-10 and procalcitonin [28][29][30] .…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis with High Cut-Off Hemodialyzers in Patients with Multi-Drug Resistant Gram-Negative Sepsis and Acute Kidney Injury: A Retrospective, Case-Control Study

Chelazzi

Villa

DʼAlfonso³

et al. 2016

Blood Purif

Self Cite

View full text Add to dashboard Cite

Background: Hemodialysis with high cut-off continuous veno-venous hemodialyzer (HCO-CVVHD) removes mediators of organ dysfunction during sepsis. This study assessed the clinical effects of HCO-CVVHD as compared to high-flux (HF) membranes during gram-negative sepsis. Methods: Intensive care unit (ICU), septic patients treated with HCO-CVVHD or HF-CVVHDF for AKI were retrospectively observed (January 2013-December 2014). Mechanical ventilation, vasopressors' requirements, ICU length of stay (LOS) and ICU in-hospital mortality were compared between groups. Results: Sixteen HCO and 8 HF patients were observed. Isolated pathogens included Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli and Pseudomonas aeruginosa. Median ratios of days-on-vasopressors and days-on-mechanical ventilation/ICU-LOS were 0.5, 1 and 0.8, 1 for HCO and HF groups (p < 0.03), respectively. ICU-LOS was 16 and 9 days (HCO- and HF-group, p = 0.03). ICU mortality rates were 37.5 and 87.5% for HCO and HF groups, respectively (p = 0.03). No statistical difference was found in in-hospital morality. Conclusion: Patients in HCO-CVVHD group spent lesser number of days on vasopressors and mechanical ventilation as a ratio to total ICU-LOS. In the same group, a reduction in ICU mortality was observed.

show abstract

“…However, currently used biomarkers are poorly investigated in specific critically ill populations. This is exemplified by the letter of Villa et al [2 ]in this issue of Blood Purification which raises pertinent questions regarding biomarker evaluation in patients undergoing extracorporeal therapy. The authors argue that biomarkers are unreliable indicators for detecting sepsis in critically ill patients because they are cleared from the circulation by any form of continuous blood filtration, including continuous renal replacement therapy (CRRT).…”

mentioning

confidence: 99%

“…Villa et al [2 ]suggest that extracorporeal PCT removal may beneficially influence evolution and outcome of sepsis. PCT is induced by primary cytokines in the inflammatory cascade and follows a cytokine-like expression pathway [15].…”

mentioning

confidence: 99%

Biomarkers of Inflammation during Continuous Renal Replacement Therapy: Sensors, Players, or Targets? A Reply to the Letter by Villa et al.

Honoré¹,

Jacobs²,

Waele³

et al. 2014

Blood Purif

View full text Add to dashboard Cite

Is Procalcitonin Reduction Indicative of Immunomodulation in Septic Patients Treated with Hemodialysis with High Cutoff Membrane?

Cited by 3 publications

References 10 publications

Organ dysfunction during continuous veno-venous high cut-off hemodialysis in patients with septic acute kidney injury: A prospective observational study

Organ dysfunction during continuous veno-venous high cut-off hemodialysis in patients with septic acute kidney injury: A prospective observational study

Hemodialysis with High Cut-Off Hemodialyzers in Patients with Multi-Drug Resistant Gram-Negative Sepsis and Acute Kidney Injury: A Retrospective, Case-Control Study

Biomarkers of Inflammation during Continuous Renal Replacement Therapy: Sensors, Players, or Targets? A Reply to the Letter by Villa et al.

Contact Info

Product

Resources

About