Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19

Clinical Immunology, Journal Year: 2020, Volume and Issue: 214, P. 108408 - 108408

Published: April 1, 2020

Language: Английский

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Prescription of CRRT: a pathway to optimize therapy

Annals of Intensive Care, Journal Year: 2020, Volume and Issue: 10(1)

Published: March 6, 2020

Abstract Severe acute kidney injury (AKI), especially when caused or accompanied by sepsis, is associated with prolonged hospitalization, progression to chronic disease (CKD), financial burden, and high mortality rate. Continuous renal replacement therapy (CRRT) a predominant form of (RRT) in the intensive care unit (ICU) due its accurate volume control, steady acid–base electrolyte correction, achievement hemodynamic stability. This manuscript reviews different aspects CRRT prescription critically ill patients severe AKI, multiorgan failure ICU. These include choice versus Intermittent extended hemodialysis (HD), life filter/dialyzer including assessment filtration fraction, anticoagulation regional citrate (RCA), prescribed delivered dose, vascular access management, timing initiation termination CRRT, AKI/sepsis adsorptive methods removing endotoxins cytokines.

Language: Английский

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Continuous renal replacement therapy with the adsorptive oXiris filter may be associated with the lower 28-day mortality in sepsis: a systematic review and meta-analysis

Critical Care, Journal Year: 2023, Volume and Issue: 27(1)

Published: July 9, 2023

Abstract Background The oXiris is a novel filter for continuous renal replacement therapy (CRRT) featuring an adsorption coating to adsorb endotoxins and remove inflammatory mediators. Given that no consensus has been reached on its potential benefits in treating sepsis, meta-analysis was conducted assess impact the clinical outcomes of this patient population. Methods Eleven databases were retrieved find relevant observational studies randomized controlled trials. Newcastle–Ottawa Scale Cochrane Risk Bias Tool used quality included studies. Grading Recommendations, Assessment, Development, Evaluation (GRADE) process employed certainty evidence. 28-day mortality primary outcome. Secondary 7-, 14-, 90-day mortality, length intensive care unit (ICU) hospital stay, ICU norepinephrine (NE) dose, interleukin-6 (IL-6) lactate levels, Sequential Organ Failure Assessment (SOFA) score. Results meta-analysis, pooling data from 14 studies, involving 695 patients, showed significant reductions [odds ratio (OR) 0.53; 95% confidence interval (CI) 0.36–0.77, p = 0.001] stay [weighted mean difference (WMD) − 1.91; CI 2.56 1.26, < 0.001)] patients with sepsis using compared other filters. Besides, SOFA score, NE IL-6 7- 14-day mortalities lower group. However, comparable. assessment ten indicated intermediate high (average score: 7.8). all four trials (RCTs) had unclear risk bias. evidence low or very level because original study design mainly RCTs bias small sample size. Conclusion treatment during CRRT may be associated 28-, mortalities, shorter stay. due evidence, effectiveness filters still uncertain. observed

Language: Английский

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Weathering the Cytokine Storm in COVID-19: Therapeutic Implications

Cardiorenal Medicine, Journal Year: 2020, Volume and Issue: 10(5), P. 277 - 287

Published: Jan. 1, 2020

<b><i>Background:</i></b> Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) recently emerged in Wuhan, Hubei-China, as responsible for the disease 2019 (COVID-19) and then spread rapidly worldwide. While most individuals remain asymptomatic or develop only mild symptoms, approximately 5% severe forms of COVID-19 characterized by distress (ARDS) multiple-organ failure (MOF) that usually require intensive-care support often yield a poor prognosis. <b><i>Summary:</i></b> The pathophysiology is far from being completely understood, lack effective treatments leads to sense urgency new therapeutic strategies based on pathophysiological assumptions. exaggerated cytokine release response viral infection, condition known (CRS) storm, emerging mechanism leading ARDS MOF COVID-19, thus endorsing hypothesis properly timed anti-inflammatory could improve patients’ clinical outcomes <b><i>Key Messages:</i></b> objective this article explore comment potential role promising immunomodulatory therapies using pharmacological nonpharmacological approaches overcome dysregulated proinflammatory COVID-19.

Language: Английский

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Targeting Cytokines, Pathogen-Associated Molecular Patterns, and Damage-Associated Molecular Patterns in Sepsis via Blood Purification

International Journal of Molecular Sciences, Journal Year: 2021, Volume and Issue: 22(16), P. 8882 - 8882

Published: Aug. 18, 2021

Sepsis is characterized by a dysregulated immune response to infections that causes life-threatening organ dysfunction and even death. When occur, bacterial cell wall components (endotoxin or lipopolysaccharide), known as pathogen-associated molecular patterns, bind pattern recognition receptors, such toll-like initiate an inflammatory for pathogen elimination. However, strong activation of the system leads cellular ultimately failure. Damage-associated patterns (DAMPs), which are released injured host cells, well-recognized triggers result in elevation cytokine levels. A storm thus amplified sustained this vicious cycle. Interestingly, during sepsis, neutrophils transition from powerful antimicrobial protectors into dangerous mediators tissue injury dysfunction. Thus, concept blood purification has evolved include cells mediators. In review, we summarize recent advances knowledge regarding role lipopolysaccharides, cytokines, DAMPs, pathogenesis sepsis. Additionally, discuss potential purification, especially adsorption technology, removing mediators, thereby serving therapeutic strategy against Finally, describe our immune-modulating system.

Language: Английский

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Blood purification therapy with a hemodiafilter featuring enhanced adsorptive properties for cytokine removal in patients presenting COVID-19: a pilot study

Critical Care, Journal Year: 2020, Volume and Issue: 24(1)

Published: Oct. 12, 2020

Abstract Background Systemic inflammation in COVID-19 often leads to multiple organ failure, including acute kidney injury (AKI). Renal replacement therapy (RRT) combination with sequential extracorporeal blood purification therapies (EBP) might support renal function, attenuate systemic inflammation, and prevent or mitigate dysfunctions COVID-19. Aim Describe overtime variations of clinical biochemical features critically ill patients treated EBP a hemodiafilter characterized by enhanced cytokine adsorption properties. Methods An observational prospective study assessing the outcome admitted ICU (February April 2020) according local practice. Main endpoints included variation IL-6 multiorgan function-scores, mortality, occurrence technical complications adverse events. Results The evaluated 37 patients. Median baseline was 1230 pg/ml (IQR 895) decreased ( p < 0.001 Kruskal-Wallis test) during first 72 h treatment, most significant decrease 24 = 0.001). reduction serum concentrations correlated improvement as measured SOFA score (rho 0.48, 0.0003). 13 6) significantly at 48 (median 8 IQR 5, Compared expected mortality rates, calculated APACHE IV, mean observed rates were 8.3% lower after treatment. best rate receiving early on stay. Premature clotting (running h) occurred (18.9% total) which featured higher effluent dose 33.6 ml/kg/h, 9) filtration fraction 31%, 7.4). No electrolyte disorders, catheter displacement, circuit disconnection, unexpected bleeding, air, thromboembolisms due venous cannulation recorded In one case, infection vascular access RRT, requiring replacement. Conclusions heparin-coated featuring properties administered showed be feasible no During experienced level reduction, attenuation dysfunction improvement, rate.

Language: Английский

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Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19)

BMC Nephrology, Journal Year: 2020, Volume and Issue: 21(1)

Published: Aug. 20, 2020

Abstract Background Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because its beneficial impact on elimination inflammatory cytokines. Methods This controlled trial conducted critically ill COVID-19 admitted state hospital affiliated to Babol University Medical Sciences, Iran who received different antiviral and antibacterial drugs, modalities respiratory treatments did not have positive clinical improvement. No randomization blindness was considered. All participants underwent three sessions resin-directed hemoperfusion using continuous renal replacement therapy a mode venovenous hemofiltration (CVVH). Results Five men five women mean age 57.30 ± 18.07 years enrolled study; six them improved after intervention. Peripheral capillary oxygen saturation (SpO2) changed each session. Mean SpO2 before 89.60% 3.94% increased 92.13% 3.28% ( p < 0.001). Serum IL-6 showed reduction from 139.70 105.62 72.06 65.87 pg/mL = 0.073); c-reactive protein decreased 136.25 84.39 78.25 38.67 mg/L P 0.016). Conclusions hemoadsorption could improve general condition most recruited severe disease; however, large prospective multicenter trials carefully selected are needed definitely evaluate efficacy patients. Trial registration The research protocol registered website Iranian Registry Clinical Trials reference number IRCT20150704023055N2 .

Language: Английский

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Endotoxin in Sepsis: Methods for LPS Detection and the Use of Omics Techniques

Diagnostics, Journal Year: 2022, Volume and Issue: 13(1), P. 79 - 79

Published: Dec. 27, 2022

Lipopolysaccharide (LPS) or endotoxin, the major cell wall component of Gram-negative bacteria, plays a pivotal role in pathogenesis sepsis. It is able to activate host defense system through interaction with Toll-like receptor 4, thus triggering pro-inflammatory mechanisms. A large amount LPS induces inappropriate activation immune system, an exaggerated inflammatory response and consequent extensive organ injury, providing basis sepsis damage. In this review, we will briefly describe endotoxin’s molecular structure its main pathogenetic action during addition, summarize different available methods for endotoxin detection special focus on wider spectrum offered by omics technologies (genomics, transcriptomics, proteomics, metabolomics) promising applications these identification specific biomarkers

Language: Английский

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New Targets for Extracorporeal Blood Purification Therapies in Sepsis

Blood Purification, Journal Year: 2022, Volume and Issue: 52(1), P. 1 - 7

Published: June 17, 2022

As highlighted by the last international consensus definition for sepsis and septic shock (sepsis-3), comes from a complex relationship between pathogen dysregulated host response. To date, treatment of is based on antimicrobial treatment, source control, organ support. Extracorporeal blood purification therapies have been proposed as adjuvant to modulate inflammatory These aim mostly at removing mediators (cytokines) endotoxins blood. However, so far, they failed clearly demonstrate an improvement in patient survival when evaluated randomized trials. Recently, new devices directly targeting primary determinants sepsis, e.g., itself immune cells, developed. This short review aimed presenting that recently developed target pathogens cells. For each, we will present mechanism action therapy discuss related literature.

Language: Английский

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Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements

World Journal of Critical Care Medicine, Journal Year: 2023, Volume and Issue: 12(2), P. 71 - 88

Published: March 7, 2023

Despite various therapies to treat sepsis, it is one of the leading causes mortality in intensive care unit patients globally. Knowledge about pathophysiology sepsis has sparked interest extracorporeal (ECT) which are intended balance dysregulation immune system by removing excessive levels inflammatory mediators.To review recent data on use ECT and assess their effects clinical outcomes.In this review, an extensive English literature search was conducted from last two decades identify sepsis. A total 68 articles peer-reviewed indexed journals were selected excluding publications with only abstracts.Results showed that techniques such as high-volume hemofiltration, coupled plasma adsorption/filtration, resin or polymer adsorbers, CytoSorb® emerging adjunct improve hemodynamic stability most published regard field septic shock reports improved survival rates lowered sequential organ failure assessment scores, lactate levels, leucocyte count, platelet interleukin- IL-6, IL-10, TNF levels.Clinical acceptance currently still limited due a lack large random trials. In addition patient-tailored therapies, future research developments targeting cellular level response expected.

Language: Английский

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