Guan Mingjing, Wang Hao, Tang Xin, Zhao Yuliang, Wang Fang, Zhang Ling, Fu Ping
Division of Nephrology, Kidney Research Laboratory, West China Hospital of Sichuan University, Chengdu, China.
Division of Osteopathic, Department of Surgery Medicine, West China Hospital of Sichuan University, Chengdu, China.
Front Med (Lausanne). 2022 Apr 8;9:789623. doi: 10.3389/fmed.2022.789623. eCollection 2022.
Sepsis/septic shock-associated acute kidney injury (S-AKI) is associated with prolonged kidney recovery and extremely high mortality. Extracorporeal blood purification therapy for the removal of endotoxin and cytokines might benefit patients with S-AKI. The purpose of this study was to compare the efficacy of adsorbing filter oXiris in the treatment of S-AKI.
This was a retrospective observational study conducted from September 2017 to June 2020 in ICU. All patients received CRRT for ≥24 h. The primary outcomes were mortality. The secondary outcomes included cardiovascular SOFA score and vasoactive-inotropic score (VIS), the SOFA, the reduction of inflammatory mediators.
A total of 136 septic shock patients with AKI were included. The interventional group (oXiris group; = 70) received CRRT with endotoxic and cytokine adsorption function hemofilter (oXiris), while the control group (ST150 group; = 66) was treated with the ST150 hemofilter. The early mortality in 7 and 14 days was significantly lower in oXiris group compared with ST150 group (7 days: 47.1 vs. 74.2%, = 0.007; 14 days: 58.5 vs. 80.3%, = 0.005), but the difference was not significant in 90-day mortality (71.4 vs. 81.8%, = 0.160). Additionally, the reduction of the SOFA score in the oXiris group at 24, 48, and 72 h CRRT was significantly faster than that in the controlled group. Meanwhile, the reduction of VIS score in the oXiris group compared with the ST150 group at 24 and 48 h after the initiation of CRRT was statistically significant ( < 0.05). Furthermore, the decreases in procalcitonin were greater in the oXiris group than those in the ST150 group at 24, 48, and 72h after initiation of CRRT. Multivariate Cox regression model demonstrated that oXiris (vs. ST150) played a favorably important role in the prognosis of septic shock patients with a hazard ratio (HR) of 0.500 (95% CI: 0.280-0.892; = 019).
Although no difference was found in 90-day mortality, oXiris might reduce the short-term (<14-day) mortality compared with ST150 groups in septic shock with AKI. Further investigation in randomized controlled trials or high-quality prospective studies is warranted to validate the present findings.
脓毒症/脓毒性休克相关急性肾损伤（S-AKI）与肾脏恢复时间延长及极高的死亡率相关。采用体外血液净化疗法清除内毒素和细胞因子可能对S-AKI患者有益。本研究旨在比较吸附滤器oXiris治疗S-AKI的疗效。
设计、地点、参与者及测量指标：这是一项于2017年9月至2020年6月在重症监护病房（ICU）进行的回顾性观察研究。所有患者接受持续肾脏替代治疗（CRRT）≥24小时。主要结局指标为死亡率。次要结局指标包括心血管系统序贯器官衰竭评估（SOFA）评分和血管活性药物-正性肌力药物评分（VIS）、SOFA评分、炎症介质的降低情况。
共纳入136例脓毒性休克合并急性肾损伤患者。干预组（oXiris组；n = 70）接受具有内毒素和细胞因子吸附功能的血液滤过器（oXiris）进行CRRT，而对照组（ST150组；n = 66）采用ST150血液滤过器治疗。oXiris组7天和14天的早期死亡率显著低于ST150组（7天：47.1%对74.2%，P = 0.007；14天：58.5%对80.3%，P = 0.005），但90天死亡率差异无统计学意义（71.4%对81.8%，P = 0.160）。此外，oXiris组在CRRT 24、48和72小时时SOFA评分的降低明显快于对照组。同时，CRRT开始后24和48小时，oXiris组的VIS评分降低与ST150组相比有统计学意义（P<0.05）。此外，CRRT开始后24、48和72小时，oXiris组降钙素原的下降幅度大于ST150组。多因素Cox回归模型显示，oXiris（与ST150相比）在脓毒性休克患者的预后中发挥了有利的重要作用，风险比（HR）为0.500（95%CI：0.280 - 0.892；P = 0.019）。
尽管90天死亡率无差异，但与ST150组相比，oXiris可能降低脓毒性休克合并AKI患者的短期（<14天）死亡率。有必要在随机对照试验或高质量前瞻性研究中进一步探究以验证本研究结果。
