Endotoxin activity trend and multi‐organ dysfunction in critically ill patients with septic shock, who received Polymyxin‐B hemadsorption: A multicenter, prospective, observational study

Author:

Cutuli Salvatore Lucio12ORCID,De Rosa Silvia34ORCID,Ferrer Ricard5,Ruiz‐Rodriguez Juan Carlos5,Forfori Francesco6,Ronco Claudio78,Antonelli Massimo12,

Affiliation:

1. Department of Emergency, Intensive Care Medicine and Anesthesia Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy

2. Department of Anesthesiology and Intensive Care Medicine Università Cattolica del Sacro Cuore Rome Italy

3. International Renal Research Institute of Vicenza Vicenza Italy

4. Centre for Medical Sciences – CISMed University of Trento Trento Italy

5. Intensive Care Department Vall d'Hebron University Hospital, SODIR Research Group, Vall d'Hebron Institut de Recerca Barcelona Spain

6. Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica Università di Pisa, Azienda Ospedaliero Universitaria Pisana Pisa Italy

7. Department of Nephrology, Dialysis and Transplantation International Renal Research Institute of Vicenza, San Bortolo Hospital Vicenza Italy

8. Department of Medicine University of Padova Padova Italy

Abstract

AbstractBackgroundThe baseline endotoxin activity (EAT0) may predict the outcome of critically ill septic patients who receive Polymyxin‐B hemadsorption (PMX‐HA), however, the clinical implications of specific EA trends remain unknown.MethodsSubgroup analysis of the prospective, multicenter, observational study EUPHAS2. We included 50 critically ill patients with septic shock and EAT0 ≥ 0.6, who received PMX‐HA. The primary outcome of the study was the EA and SOFA score progression from T0 to 120 h afterwards (T120). Secondary outcomes included the EA and SOFA score progression in whom had EA at 48 h (EAT48) < 0.6 (EA responders, EA‐R) versus who had not (EA non‐responders, EA‐NR).ResultsSeptic shock was mainly caused by 27 abdominal (54%) and 17 pulmonary (34%) infections, predominantly due to Gram negative bacteria (39 patients, 78%). The SAPS II score was 67.5 [52.8–82.3] and predicted a mortality rate of 75%. Between T0 and T120, the EA decreased (p < 0.001), while the SOFA score and the Inotropic Score (IS) improved (p < 0.001). In comparison with EA‐NR (18 patients, 47%), the EA‐R group (23 patients, 53%) showed faster IS improvement and lower requirement of continuous renal replacement therapy (CRRT) during the ICU stay. Overall hospital mortality occurred in 18 patients (36%).ConclusionsIn critically ill patients with septic shock and EAT0 ≥ 0.6 who received PMX‐HA, EA decreased and SOFA score improved over 120 h. In whom high EA resolved within 48 h, IS improvement was faster and CRRT requirement was lower compared with patients with EAT48 ≥ 0.6.

Funder

Toray Industries

Publisher

Wiley

Subject

Biomedical Engineering,General Medicine,Biomaterials,Medicine (miscellaneous),Bioengineering

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