Liao Xiu-Yu, Chen Yu-Ting, Liu Ming-Jun, Liao Qiu-Xia, Lin Jian-Dong, Lin Hai-Rong, Huang Ying-Hong, Zhou Ye
Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
Department of Gastroenterology, Fuzhou NO.1 Hospital, Fuzhou, Fujian Province, China.
Shock. 2024 Oct 1;62(4):529-538. doi: 10.1097/SHK.0000000000002437. Epub 2024 Aug 14.
Objective: The objective of this study is to assess and compare the efficacy of oXiris with conventional continuous renal replacement therapy (CRRT) in managing severe abdominal infections. Methods: A retrospective analysis encompassing cases from 2017 to 2023 was conducted at the Department of Critical Care Medicine within the First Affiliated Hospital of Fujian Medical University. Parameters including heart rate (HR), mean arterial pressure (MAP), oxygenation index, lactate (Lac), platelet count, neutrophil ratio, procalcitonin, C-reactive protein (CRP), interleukin 6 (IL-6), norepinephrine dosage, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA) were recorded prior to treatment initiation, at 24 h, and 72 h after treatment for both the oXiris and conventional CRRT groups. In addition, the duration of respiratory support, CRRT treatment, length of stay in the intensive care unit (ICU), total hospitalization period, and mortality rates at 14 and 28 days for both groups were recorded. Results: 1) Within the conventional CRRT group, notable enhancement was observed solely in Lac levels at 24 h after treatment compared with pretreatment levels. In addition, at 72 h after treatment, improvements were evident in HR, Lac, CRP, and IL-6 levels. 2) Conversely, the oXiris group exhibited improvements in HR, MAP, Lac, oxygenation index, neutrophil ratio, and IL-6 at 24 h after treatment when compared with baseline values. In addition, reductions were observed in APACHE II and SOFA scores. At 72 h after treatment, all parameters demonstrated enhancement except for platelet count. 3) Analysis of the changes in the indexes (Δ) between the two groups at 24 h after treatment revealed variances in HR, MAP, Lac, norepinephrine dosage, CRP levels, IL-6 levels, APACHE II scores, and SOFA scores. 4) The Δ indexes at 72 h after treatment indicated more significant improvements following oXiris treatment for both groups, except for procalcitonin. 5) The 14-day mortality rate (24.4%) exhibited a significant reduction in the oXiris group when compared with the conventional group (43.6%). However, no significant difference was observed in the 28-day mortality rate between the two groups. 6) Subsequent to multifactorial logistic regression analysis, the results indicated that oXiris treatment correlated with a noteworthy decrease in the 14-day and 28-day mortality rates associated with severe abdominal infections, by 71.3% and 67.6%, respectively. Conclusion: oXiris demonstrates clear advantages over conventional CRRT in the management of severe abdominal infections. Notably, it reduces the fatality rates, thereby establishing itself as a promising and potent therapeutic option.
本研究旨在评估和比较oXiris与传统连续性肾脏替代疗法（CRRT）在治疗严重腹部感染方面的疗效。方法：在福建医科大学附属第一医院重症医学科对2017年至2023年的病例进行回顾性分析。记录oXiris组和传统CRRT组在治疗开始前、治疗后24小时和72小时的参数，包括心率（HR）、平均动脉压（MAP）、氧合指数、乳酸（Lac）、血小板计数、中性粒细胞比例、降钙素原、C反应蛋白（CRP）、白细胞介素6（IL-6）、去甲肾上腺素剂量、急性生理与慢性健康状况评分系统II（APACHE II）和序贯器官衰竭评估（SOFA）。此外，记录两组的呼吸支持时间、CRRT治疗时间、重症监护病房（ICU）住院时间、总住院时间以及14天和28天的死亡率。结果：1）在传统CRRT组中，与治疗前水平相比，仅在治疗后24小时的Lac水平有显著提高。此外，在治疗后72小时，HR、Lac、CRP和IL-6水平有明显改善。2）相反，oXiris组在治疗后24小时与基线值相比，HR、MAP、Lac、氧合指数、中性粒细胞比例和IL-6有所改善。此外，APACHE II和SOFA评分降低。在治疗后72小时，除血小板计数外，所有参数均有改善。3）对两组治疗后24小时指标变化（Δ）的分析显示，HR、MAP、Lac、去甲肾上腺素剂量、CRP水平、IL-6水平、APACHE II评分和SOFA评分存在差异。4）治疗后72小时的Δ指标表明，除降钙素原外，oXiris治疗后两组的改善更为显著。5）oXiris组的14天死亡率（24.4%）与传统组（43.6%）相比显著降低。然而，两组的28天死亡率没有显著差异。6）多因素逻辑回归分析结果表明，oXiris治疗与严重腹部感染相关的14天和28天死亡率显著降低相关，分别降低了71.3%和67.6%。结论：在治疗严重腹部感染方面，oXiris比传统CRRT具有明显优势。值得注意的是，它降低了死亡率，从而成为一种有前景且有效的治疗选择。
