Effect of CytoSorb Coupled with Hemodialysis on Interleukin-6 and Hemodynamic Parameters in Patients with Systemic Inflammatory Response Syndrome: A Retrospective Cohort Study

被引:8
|
作者
Persic, Vanja [1 ,2 ]
Jerman, Alexander [1 ]
Vrecko, Marija Malgaj [1 ,2 ]
Berden, Jernej [2 ,3 ]
Gorjup, Vojka [2 ,3 ]
Stecher, Adela [2 ,4 ]
Lukic, Milica [2 ,5 ]
Jereb, Matjaz [2 ,5 ]
Stupica, Gordana Taleska [2 ,4 ]
Gubensek, Jakob [1 ,2 ]
机构
[1] Univ Med Ctr Ljubljana, Ctr Acute & Complicated Dialysis & Vasc Access, Dept Nephrol, Ljubljana 1000, Slovenia
[2] Univ Ljubljana, Fac Med, Ljubljana 1000, Slovenia
[3] Univ Med Ctr Ljubljana, Ctr Intens Internal Med, Ljubljana 1000, Slovenia
[4] Univ Med Ctr Ljubljana, Dept Anesthesiol & Surg Intens Therapy, Ljubljana 1000, Slovenia
[5] Univ Med Ctr Ljubljana, Dept Infect Dis, Ljubljana 1000, Slovenia
关键词
hemoadsorption; cytokines; dialysis; interleukin-6; CONTINUOUS VENOVENOUS HEMOFILTRATION; SEPTIC SHOCK; PLASMA-CONCENTRATION; SOFA SCORE; APACHE-II; PROCALCITONIN; CYTOKINES; SEVERITY; SEPSIS; VALIDATION;
D O I
10.3390/jcm11247500
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Excessive release of cytokines during systemic inflammatory response syndrome (SIRS) often leads to refractory hypotension and multiple organ failure with high mortality. Cytokine removal with hemoadsorption has emerged as a possible adjuvant therapy, but data on interleukin-6 (IL-6) reduction and outcomes in clinical practice are scarce. We aimed to evaluate the effect of CytoSorb hemoadsorption on laboratory and clinical outcomes in shocked patients with SIRS. We designed a retrospective analysis of all patients with SIRS treated with CytoSorb in intensive care units (ICU). IL-6, laboratory and hemodynamic parameters were analyzed at approximate time intervals during CytoSorb treatment in the whole cohort and in a subgroup with septic shock. Observed and predicted mortality rates were compared. We included 118 patients with various etiologies of SIRS (septic shock 69%, post-resuscitation shock 16%, SIRS with acute pancreatitis 6%, other 9%); in all but one patient, CytoSorb was coupled with renal replacement therapy. A statistically significant decrease in IL-6 and vasopressor index with an increase in pH and mean arterial pressure was observed from 6 h onward. The reduction of lactate became significant at 48 h. Results were similar in a subgroup of patients with septic shock. Observed ICU and in-hospital mortalities were lower than predicted by Sequential Organ Failure Assessment (SOFA) (61% vs. 79%, p = 0.005) and Acute Physiology and Chronic Health Evaluation (APACHE) II (64% vs. 78%, p = 0.031) scores. To conclude, hemoadsorption in shocked patients with SIRS was associated with a rapid decrease in IL-6 and hemodynamic improvement, with improved observed vs. predicted survival. These results need to be confirmed in a randomized study.
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页数:13
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