Division of Nephrology, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA,
Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism; University of Kentucky, Lexington, Kentucky, USA.
Blood Purif. 2024;53(6):476-485. doi: 10.1159/000535773. Epub 2023 Dec 16.
The FDA authorized the emergency use of enhanced hemoadsorption with oXiris in critically ill adult COVID patients with respiratory failure or severe disease to reduce inflammation. In this study, we evaluated critically ill adult COVID patients with acute kidney injury (AKI) who were exposed versus not exposed to enhanced hemoadsorption with oXiris during continuous renal replacement therapy (CRRT).
Retrospective cohort study of critically ill adult COVID patients with AKI requiring CRRT. Exposure to oXiris was defined as receiving oXiris for >12 cumulative hours and more than one-third of the time within the first 72 h of CRRT. Study outcomes included filter-specific performance metrics and clinical outcomes such as ventilator requirement, mortality, and dialysis dependence. Inverse probability treatment weighting was used to balance potential confounders in weighted regression models.
14,043 h of CRRT corresponding to 85 critically ill adult patients were analyzed. Among these, 2,736 h corresponded to oXiris exposure (n = 25 patients) and 11,307 h to a standard CRRT filter (n = 60 patients). Transmembrane pressures (TMPs) increased rapidly and were overall higher with oXiris versus standard filter, but filter life (median of 36.3 vs. 33.1 h, p = 0.913, respectively) and filter/clotting alarms remained similar in both groups. In adjusted models, oXiris exposure was not independently associated with the composite of hospital mortality and dialysis dependence at discharge (OR 2.13, 95% CI: 0.98-4.82, p = 0.06), but it was associated with fewer ventilator (β = -15.02, 95% CI: -29.23 to -0.82, p = 0.04) and intensive care unit days (β = -14.74, 95% CI: -28.54 to -0.95, p = 0.04) in survivors.
DISCUSSION/CONCLUSION: In critically ill adult COVID patients with AKI requiring CRRT, oXiris filters exhibited higher levels of TMP when compared to a standard CRRT filter, but no differences in filter life and filter/clotting alarm profiles were observed. The use of oXiris was not associated with improvement in clinical outcomes such as hospital mortality or dialysis dependence at discharge.
美国食品药品监督管理局批准了使用 oXiris 进行增强型血液吸附治疗危重症成人 COVID 患者呼吸衰竭或严重疾病，以减轻炎症。在这项研究中，我们评估了接受或未接受 oXiris 增强型血液吸附治疗的危重症 COVID 合并急性肾损伤（AKI）患者在连续性肾脏替代治疗（CRRT）期间的临床结局。
这是一项回顾性队列研究，纳入了需要 CRRT 的危重症 COVID 合并 AKI 患者。暴露于 oXiris 定义为接受 oXiris 治疗超过 12 个累积小时，且在前 72 小时内接受 oXiris 治疗的时间超过三分之一。研究结局包括滤器特异性性能指标和临床结局，如呼吸机需求、死亡率和透析依赖。采用逆概率处理加权法在加权回归模型中平衡潜在混杂因素。
分析了 14043 小时的 CRRT 数据，对应 85 名危重症 COVID 合并 AKI 患者。其中，2736 小时对应 oXiris 暴露（n=25 例患者），11307 小时对应标准 CRRT 滤器（n=60 例患者）。与标准滤器相比，oXiris 组的跨膜压（TMP）迅速升高且总体更高，但两组的滤器寿命（中位数分别为 36.3 和 33.1 小时，p=0.913）和滤器/凝血报警相似。在调整后的模型中，oXiris 暴露与出院时的医院死亡率和透析依赖的复合结局无关（OR 2.13，95%CI：0.98-4.82，p=0.06），但与幸存者的呼吸机天数（β=-15.02，95%CI：-29.23 至 -0.82，p=0.04）和 ICU 天数（β=-14.74，95%CI：-28.54 至 -0.95，p=0.04）减少有关。
讨论/结论：在需要 CRRT 的危重症 COVID 合并 AKI 患者中，与标准 CRRT 滤器相比，oXiris 滤器的 TMP 水平更高，但滤器寿命和滤器/凝血报警特征无差异。使用 oXiris 并不能改善临床结局，如出院时的医院死亡率或透析依赖。
