Best-practice IgM- and IgA-enriched immunoglobulin use in patients with sepsis

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

Published: Oct. 7, 2020

Abstract Background Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. Despite treatment being in line with current guidelines, mortality remains high those septic shock. Intravenous immunoglobulins represent promising therapy modulate both the pro- and anti-inflammatory processes can contribute elimination of pathogens. In this context, there evidence benefits immunoglobulin M (IgM)- A (IgA)-enriched for sepsis. This manuscript aims summarize relevant data provide expert opinions on best practice use an IgM- IgA-enriched (Pentaglobin) adult patients Main text hyperinflammation immunosuppression may benefit most from (Pentaglobin). Patients present phenotypes that manifest throughout body, whilst clinical characteristics are less clear. Potential biomarkers include elevated procalcitonin, interleukin-6, endotoxin activity C-reactive protein, although thresholds these not well-defined. Convenient identifying stage immune-paralysis still matter debate, though human leukocyte antigen–antigen D related expression monocytes, lymphocyte count viral reactivation have been proposed. The timing potentially more critical efficacy compared who immunosuppressed stage. Due lack evidence, definitive dosage recommendations either population cannot be made, we suggest should receive initial bolus at rate up 0.6 mL (30 mg)/kg/h 6 h followed continuous maintenance 0.2 (10 mg)/kg/hour ≥ 72 (total dose 0.9 g/kg). For patients, conservative (0.2 [10 mg]/kg/h) h, without 0.72 Conclusions Two distinct populations Pentaglobin described review. However, further required strengthen support given here regarding timing, duration treatment.

Language: Английский

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Phagocytosis–Inflammation Crosstalk in Sepsis: New Avenues for Therapeutic Intervention

Shock, Journal Year: 2020, Volume and Issue: 54(5), P. 606 - 614

Published: June 8, 2020

ABSTRACT Phagocytosis is a complex process by which cells within most organ systems remove pathogens and cell debris. usually followed inflammatory pathway activation, promotes pathogen elimination inhibits growth. Delayed the first step in sepsis development key factor resolution. thus has an important role during likely contributes to all of its clinical stages. However, only few studies have specifically explored characterized phagocytic activity sepsis. Here, we describe processes that occur as part immune response preceding onset identify elements phagocytosis might constitute predictive marker outcomes. First, detail features phagocytosis, including main receptors signaling hallmarks associated with different processes. We then discuss how initial events phagosome formation cytoskeletal remodeling be known features, such cytokine-driven hyperinflammatory immunosuppression. Finally, highlight unresolved mechanisms progression need for cross-disciplinary approaches link complexity disease basic cellular molecular mechanisms.

Language: Английский

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Continuous Renal Replacement Therapy With oXiris Filter May Not be an Effective Resolution to Alleviate Cytokine Release Syndrome in Non-AKI Patients With Severe and Critical COVID-19

Frontiers in Pharmacology, Journal Year: 2022, Volume and Issue: 13

Published: Feb. 4, 2022

In this study, we aimed to determine whether continuous renal replacement therapy (CRRT) with oXiris filter may alleviate cytokine release syndrome (CRS) in non-AKI patients severe and critical coronavirus disease 2019 (COVID-19). A total of 17 COVID-19 treated between February 14 March 26, 2020 were included randomly divided into intervention group control according the random number table. Patients immediately received CRRT plus conventional treatment, while those only treatment. Demographic data collected collated at admission. During ICU hospitalization, concentrations circulating cytokines inflammatory chemokines, including IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, quantitatively measured daily reflect degree CRS induced by SARS-CoV-2 infection. Clinical data, severity white blood cell count (WBC), neutrophil proportion (NEUT%), lymphocyte (LYMPH), percentage (LYM%), platelet (PLT), C-reaction protein (CRP), high sensitivity C-reactive (hs-CRP), alanine aminotransferase (ALT), aspartate (AST), bilirubin (TB), albumin (ALB), serum creatinine (SCr), D-Dimer, fibrinogen (FIB), hospital days sequential organ failure assessment (SOFA) score obtained from medical records, then compared two groups. Age, SCr significantly differed Besides IL-2 concentration that was lower on day 2 than 1 group, IL-6 higher 1, similar IL-10 5, there no significant differences To sum up, not effectively COVID-19. Thus, its application these should be considered caution avoid increasing unnecessary burden society individuals making already overwhelmed system even more strained (IRB number: IRB-AF/SC-04).

Language: Английский

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Effect of oXiris-CVVH on the Clinical Outcomes of Patients with Septic Shock: An Inverse Probability of Treatment-Weighted Analysis

Blood Purification, Journal Year: 2022, Volume and Issue: 51(12), P. 972 - 989

Published: Jan. 1, 2022

Limited previous studies had proved that oXiris-continuous veno-venous hemofiltration (CVVH) could decrease endotoxins and inflammatory factors, thereby improving circulation's stability. However, conclusive data are lacking regarding the comparison between oXiris membrane (with function of removing decreasing factors) AN69 filters only inflammatory) on mortality patients with septic shock. The potential mechanisms might influence shock remain unexplored.This is a single-center, retrospective cohort study. experimental group (30 shock) was treated oXiris-CVVH, control (46 filter-CVVH. We employed inverse probability treatment-weighting method (IPTW), doubly robust estimation, mediating effect analysis to analyze those clinical outcomes, special focus results 28-day mortality, 72-h lactate, need for norepinephrine (NE) in next 72 h.A total 76 who received blood purification therapies were enrolled. After IPTW, differences patient characteristics have been minimized. higher than treatment (73.3% vs. 47.3%, p < 0.001; median survival time: 10 ≥28 days, log-rank = 0.0366). And 25% 50% demand NE h different groups (median time demand: 24 >72 h, 0.0126; 0.0322). lactic acid level white cell (WBC) counts lower group. lactate fully mediated effects after confounds adjustment.For patients, use oXiris-CVVH associated appeared reduce dosage, PCT, WBC counts, as compared AN69-CVVH.

Language: Английский

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Single-Center Experience With the Seraph-100® Microbind® Affinity Blood Filter in Patients With SARS-CoV-2 Infection and Septic Shock at a Military Treatment Facility

Military Medicine, Journal Year: 2023, Volume and Issue: 188(7-8), P. e2670 - e2674

Published: Feb. 28, 2023

ABSTRACT Introduction Coronavirus disease 2019 (COVID-19) infection is characterized by a dysregulated inflammatory response, which may result in severe hemodynamic instability and septic shock. The Seraph-100® Microbind® Affinity Blood Filter commercially available extracorporeal pathogen absorbent device with the ability to bind pathogens cytokines present within blood. Our study aimed evaluate efficacy of for patients acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Materials Methods A retrospective review was performed use blood filter at Single Center tertiary-care facility Brooke Army Medical from 2020 2021. Nine (11 treatments) were completed SARS-CoV-2 used combination continuous renal replacement therapy slow low-efficiency dialysis or directly parallel membrane oxygenation circuit. Results Within this cohort, there statistically significant improvement following clinical parameters comparing values before after treatment filter: Mean arterial pressure (mmHg) (64.2 ± 2.36 vs. 76.2 2.68; P &lt; .001), heart rate (beats per minute) (128 6.6 100.3 6.07; administered fraction oxygen (%) (74.4 10.58 60.3 10.35; serum lactate (mmol/L) (6.14 1.25 2.8 1.14; = .0095), pH (7.29 0.03 7.39 0.04; .0203). There improvements vasopressor requirements: norepinephrine (mcg/min) (36.3 4.74 8.3 3.92; vasopressin (units/min) (0.04 0.004 0.02 0.003; dobutamine (mcg/kg/min) (2.3 1.00 0.2 0.75; .006) angiotensin II (ng/kg/min) (34.5 6.4 3.3 5.26; .001). Conclusions associated clinically decreased requirements shock infection.

Language: Английский

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