Wang Juan, Wei Shu-Run, Ding Tong, Zhang Li-Ping, Weng Zhi-Hua, Cheng Ming, Zhou Yang, Zhang Meng, Liu Fang-Jun, Yan Bei-Bei, Wang Dan-Feng, Sun Ming-Wen, Cheng Wei-Xin
Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China.
Department of Emergency, Peking University International Hospital, Beijing 102206, China.
World J Clin Cases. 2023 Sep 16;11(26):6073-6082. doi: 10.12998/wjcc.v11.i26.6073.
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.
To explore the effects of CRRT and oXiris in shortening the resuscitation time and modifying the host response by reducing inflammation mediator levels.
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.
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.
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.
血液系统恶性肿瘤（HM）患者感染性休克的死亡率仍显著高于非HM患者。由于患者存在不可逆的免疫功能低下状态，较长的复苏时间肯定有害。通过使用oXiris进行连续性肾脏替代治疗（CRRT）来缩短复苏时间，可能是治疗这类患者的一个有吸引力的策略。
探讨CRRT及oXiris在缩短复苏时间及通过降低炎症介质水平改变宿主反应方面的作用。
45例HM患者被诊断为感染性休克，并于2018年至2022年期间接受CRRT治疗。根据用于CRRT的血液滤过器将患者分为两组（oXiris组，n = 26；M150组，n = 19）。我们比较了两组CRRT 7天后的负平衡天数和总液体平衡。还比较了两组不同时间点的心率、去甲肾上腺素剂量、序贯器官衰竭评估（SOFA）评分和血乳酸水平。检测oXiris组26例患者血液中炎症介质水平，以进一步推断可能的机制。
oXiris组CRRT 7天后的平均总液体平衡显著低于M150血液滤过器组患者。接受oXiris治疗的患者CRRT后的SOFA评分在CRRT后第1天（d1）、d3和d7显著低于治疗前；这些参数在d7时也显著低于对照组。oXiris治疗后d3和d7的乳酸水平显著低于治疗前。两组在其他时间点上述参数无显著差异。在oXiris组，降钙素原水平在d7时下降，而白细胞介素-6和肿瘤坏死因子水平在治疗后d3和d7时显著下降。
使用oXiris血液滤过器的CRRT可能通过减少炎症介质来改善血流动力学，在缩短复苏期和减少复苏阶段的总液体平衡方面发挥作用。
