Zheng Feng, Wang Yi-Lan, Zhou Wei-Yi, Zhang Jing, Lu Min, Pan Ni-Fang, He Jian, Zhang Qian, Cao Lan, Wu Jiang-Song, Gu Yan, Qiu Li-Hua, Ye Hong-Wei
Department of Intensive Care Unit, Suzhou University Affiliated Changshu Hospital, Changshu, China.
BMC Nephrol. 2024 Dec 18;25(1):456. doi: 10.1186/s12882-024-03897-0.
Critical bedside ultrasound is widely used in clinical practice, and it can monitor renal perfusion. The reduction of renal perfusion and inflammatory injury are two contributing factors to sepsis-associated acute kidney injury (SA-AKI).The aim of this study was to examine whether the oXiris filter was useful in the continuous renal replacement therapy(CRRT) treatment of SA-AKI patients.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We performed a retrospective single-center observational study and enrolled two hundred and forty-three SA-AKI patients from January 2022 to December 2023, who were divided into the oXiris group (n = 88) and the control group (n = 155). The primary endpoints were the 28-day recovery of renal function and 28-day all-cause mortality. The secondary endpoints included renal Doppler markers (RRI, RVSI, and PDU), SOFA, vasoactive-inotropic score (VIS), inflammatory markers (PCT, CRP, IL-10 and TNFα), lactate level, and length of stay in ICU and hospital.
For the primary endpoint, the rates of complete recovery, partial recovery, and dialysis dependence were observed to be 60.3%, 13.6%, and 26.1% in the oXiris group, respectively, compared to 63.9%, 15.5%, and 20.6% in the control group. The 28-day all-cause mortality was not different in the two groups (22.7% vs. 27.1%). For the secondary endpoint, the oXiris group exhibited greater reductions in VIS scores compared to the control group within the first 24 h (p = 0.001) and 48 h (p < 0.001) of CRRT. Following 48-h of CRRT, lactate levels in the oXiris group were significantly lower than those in the control group (p = 0.014). Prior to CRRT, levels of IL-6 were higher in the oXiris group (p = 0.036), but these differences were not significant after CRRT (p > 0.05). The levels of RRI at T1 (p = 0.002) and T2 (p = 0.001) were lower in the oXiris group than in the control group. Even after adjusting for AKI stage, multivariable Cox regression analysis showed that SOFA and inflammatory factors (TNFα, IL-10, and IL-6), oXiris were significantly associated with a lower 28-day mortality among SA-AKI patients when compared to M150 [HR = 0.466, 95%CI 0.233-0.934, p = 0.031].
Our findings suggest that the use of the oXiris filter in CRRT is associated with reduced inflammatory injury and improvement in renal perfusion. However, it is not associated with improved 28-day recovery of renal function and 28-day all-cause mortality.
床旁危急重症超声在临床实践中广泛应用，可用于监测肾脏灌注。肾脏灌注减少和炎症损伤是脓毒症相关性急性肾损伤（SA-AKI）的两个促成因素。本研究旨在探讨oXiris滤器在SA-AKI患者连续性肾脏替代治疗（CRRT）中是否有用。
设计、地点、参与者及测量指标：我们进行了一项回顾性单中心观察性研究，纳入了2022年1月至2023年12月期间的243例SA-AKI患者，将其分为oXiris组（n = 88）和对照组（n = 155）。主要终点为肾功能28天恢复情况和28天全因死亡率。次要终点包括肾脏多普勒指标（肾阻力指数、肾血管阻力指数和阻力血管搏动指数）、序贯器官衰竭评估（SOFA）、血管活性药物评分（VIS）、炎症指标（降钙素原、C反应蛋白、白细胞介素-10和肿瘤坏死因子α）、乳酸水平以及重症监护病房（ICU）和医院住院时间。
对于主要终点，oXiris组的完全恢复率、部分恢复率和透析依赖率分别为60.3%、13.6%和26.1%，而对照组分别为63.9%、15.5%和20.6%。两组28天全因死亡率无差异（22.7%对27.1%）。对于次要终点，在CRRT开始后的最初24小时（p = 0.001）和48小时（p < 0.001）内，oXiris组的VIS评分较对照组降低幅度更大。CRRT治疗48小时后，oXiris组的乳酸水平显著低于对照组（p = 0.014）。CRRT前，oXiris组白细胞介素-6水平较高（p = 0.036），但CRRT后这些差异无统计学意义（p > 0.05）。oXiris组在T1（p = 0.002）和T2（p = 0.001）时的肾阻力指数水平低于对照组。即使在调整急性肾损伤分期后，多变量Cox回归分析显示，与M150相比，oXiris在SA-AKI患者中与较低的28天死亡率显著相关[风险比（HR）= 0.466，95%置信区间（CI）0.233 - 0.934，p = 0.031]。
我们的研究结果表明，在CRRT中使用oXiris滤器与炎症损伤减轻和肾脏灌注改善相关。然而，它与肾功能28天恢复情况和28天全因死亡率的改善无关。
