Schittek Gregor A, Zoidl Philipp, Eichinger Michael, Orlob Simon, Simonis Holger, Rief Martin, Metnitz Philipp, Fellinger Tobias, Soukup Jens
Department of Anaesthesiology and Intensive Care Medicine, Division of General Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
Austrian Centre for Documentation and Quality Assurance in Intensive Care, Vienna, Austria.
Ann Intensive Care. 2020 Nov 18;10(1):154. doi: 10.1186/s13613-020-00772-7.
Haemoadsorption has been described as an effective way to control increased pro- and anti-inflammatory mediators ("cytokine storm") in septic shock patients. No prospective or randomised clinical study has yet confirmed these results. However, no study has yet prospectively specifically investigated patients in severe septic shock with sepsis-associated acute kidney injury (SA-AKI). Therefore, we aimed to examine whether haemoadsorption could influence intensive care unit (ICU) and hospital mortality in these patients. Furthermore, we examined the influence of haemoadsorption on length of stay in the ICU and therapeutic support.
Retrospective control group and prospective intervention group design in a tertiary hospital in central Europe (Germany). Intervention was the implementation of haemoadsorption for patients in septic shock with SA-AKI. 76 patients were included in this analysis.
Severity of illness as depicted by APACHE II was higher in patients treated with haemoadsorption. Risk-adjusted ICU mortality rates (O/E ratios) did not differ significantly between the groups (0.80 vs. 0.83). We observed in patients treated with haemoadsorption a shorter LOS and shorter therapeutic support such as catecholamine dependency and duration of RRT. However, in multivariate analysis (logistic regression for mortality, competing risk for LOS), we found no significant differences between the two groups.
The implementation of haemoadsorption for patients in septic shock with acute renal failure did not lead to a reduction in ICU or hospital mortality rates. Despite univariate analysis delivering some evidence for a shorter duration of ICU-related treatments in the haemoadsorption group, these results did not remain significant in multivariate analysis. Trial registration CytoSorb registry https://clinicaltrials.gov/ct2/show/NCT02312024 . December 9, 2014.
https://www.cytosorb-registry.org/ (registration for content acquisition is necessary).
血液吸附已被描述为控制脓毒性休克患者促炎和抗炎介质增加（“细胞因子风暴”）的有效方法。尚无前瞻性或随机临床研究证实这些结果。然而，尚无研究前瞻性地专门调查伴有脓毒症相关急性肾损伤（SA-AKI）的严重脓毒性休克患者。因此，我们旨在研究血液吸附是否会影响这些患者的重症监护病房（ICU）和医院死亡率。此外，我们研究了血液吸附对ICU住院时间和治疗支持的影响。
在欧洲中部（德国）一家三级医院采用回顾性对照组和前瞻性干预组设计。干预措施是对伴有SA-AKI的脓毒性休克患者实施血液吸附。本分析纳入了76例患者。
血液吸附治疗的患者中，APACHE II所描述的疾病严重程度更高。两组之间风险调整后的ICU死亡率（O/E比率）无显著差异（0.80对0.83）。我们观察到接受血液吸附治疗的患者住院时间较短，且儿茶酚胺依赖和肾脏替代治疗（RRT）持续时间等治疗支持时间较短。然而，在多变量分析（死亡率的逻辑回归，住院时间的竞争风险）中，我们发现两组之间无显著差异。
对伴有急性肾衰竭的脓毒性休克患者实施血液吸附并未降低ICU或医院死亡率。尽管单变量分析为血液吸附组ICU相关治疗持续时间较短提供了一些证据，但这些结果在多变量分析中并不显著。试验注册：CytoSorb注册库https://clinicaltrials.gov/ct2/show/NCT02312024。2014年12月9日。
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