Continuous renal replacement therapy with oXiris in patients with hematologically malignant septic shock: A retrospective study.

BACKGROUND

The mortality rate from septic shock in patients with hematological malignancies (HMs) remains significantly higher than that in patients without HMs. A longer resuscitation time would definitely be harmful because of the irreversibly immunocompromised status of the patients. Shortening the resuscitation time through continuous renal replacement therapy (CRRT) with oXiris would be an attractive strategy in managing such patients.

AIM

To explore the effects of CRRT and oXiris in shortening the resuscitation time and modifying the host response by reducing inflammation mediator levels.

METHODS

Forty-five patients with HM were diagnosed with septic shock and underwent CRRT between 2018 and 2022. Patients were divided into two groups based on the hemofilter used for CRRT (oXiris group, = 26; M150 group, = 19). We compared the number of days of negative and total fluid balance after 7 d of CRRT between the groups. The heart rate, norepinephrine dose, Sequential Organ Failure Assessment (SOFA) score, and blood lactic acid levels at different time points in the two groups were also compared. Blood levels of inflammatory mediators in the 26 patients in the oXiris group were measured to further infer the possible mechanism.

RESULTS

The average total fluid balance after 7 d of CRRT in the oXiris group was significantly lower than that of patients in the M150 hemofilter group. The SOFA scores of patients after CRRT with oXiris therapy were significantly lower than those before treatment on day 1 (d1), d3 and d7 after CRRT; these parameters were also significantly lower than those of the control group on d7. The lac level after oXiris therapy was significantly lower than that before treatment on d3 and d7 after CRRT. There were no significant differences in the above parameters between the two groups at the other time points. In the oXiris group, procalcitonin levels decreased on d7, whereas interleukin-6 and tumor necrosis factor levels decreased significantly on d3 and d7 after treatment.

CONCLUSION

CRRT with oXiris hemofilter may improve hemodynamics by reducing inflammatory mediators and playing a role in shortening the resuscitation period and decreasing total fluid balance in the resuscitation phases.