Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2023; 11(26): 6073-6082
Published online Sep 16, 2023. doi: 10.12998/wjcc.v11.i26.6073
Continuous renal replacement therapy with oXiris® in patients with hematologically malignant septic shock: A retrospective study
Juan Wang, Shu-Run Wei, Tong Ding, Li-Ping Zhang, Zhi-Hua Weng, Ming Cheng, Yang Zhou, Meng Zhang, Fang-Jun Liu, Bei-Bei Yan, Dan-Feng Wang, Ming-Wen Sun, Wei-Xin Cheng
Juan Wang, Shu-Run Wei, Tong Ding, Li-Ping Zhang, Zhi-Hua Weng, Ming Cheng, Yang Zhou, Meng Zhang, Fang-Jun Liu, Bei-Bei Yan, Dan-Feng Wang, Ming-Wen Sun, Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
Wei-Xin Cheng, Department of Emergency, Peking University International Hospital, Beijing 102206, China
Author contributions: Wang J and Cheng WX were responsible for research design, statistics and paper writing; Wei SR, Ding T, Zhang LP, Weng ZH, Cheng M, Zhou Y, Zhang M, Liu FJ, Yan BB, Wang DF, and Sun MW were responsible for the collation of data; all authors proofed the manuscript.
Supported by Hebei Health Science and Education Project, No. 20200852.
Institutional review board statement: This study was approved by the hospital’s ethics committee.
Informed consent statement: Patients were not required to provide informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient or their representative family members agreed to the treatment by written consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Some or all data, models, or codes generated or used during the study are available from the corresponding author upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Xin Cheng, MD, Doctor, Emergency Department, Peking University International Hospital, No. 1 Life Park Road, Life Science Park of Zhong Guancun, Changping District, Beijing 102206, China. 18911652172@163.com
Received: April 21, 2023
Peer-review started: April 21, 2023
First decision: June 14, 2023
Revised: July 4, 2023
Accepted: July 14, 2023
Article in press: July 14, 2023
Published online: September 16, 2023
Processing time: 139 Days and 23.9 Hours
Abstract
BACKGROUND

The mortality rate from septic shock in patients with hematological malignancies (HMs) remains significantly higher than that in patients without HMs. A longer resuscitation time would definitely be harmful because of the irreversibly immunocompromised status of the patients. Shortening the resuscitation time through continuous renal replacement therapy (CRRT) with oXiris® would be an attractive strategy in managing such patients.

AIM

To explore the effects of CRRT and oXiris® in shortening the resuscitation time and modifying the host response by reducing inflammation mediator levels.

METHODS

Forty-five patients with HM were diagnosed with septic shock and underwent CRRT between 2018 and 2022. Patients were divided into two groups based on the hemofilter used for CRRT (oXiris® group, n = 26; M150 group, n = 19). We compared the number of days of negative and total fluid balance after 7 d of CRRT between the groups. The heart rate, norepinephrine dose, Sequential Organ Failure Assessment (SOFA) score, and blood lactic acid levels at different time points in the two groups were also compared. Blood levels of inflammatory mediators in the 26 patients in the oXiris® group were measured to further infer the possible mechanism.

RESULTS

The average total fluid balance after 7 d of CRRT in the oXiris® group was significantly lower than that of patients in the M150 hemofilter group. The SOFA scores of patients after CRRT with oXiris® therapy were significantly lower than those before treatment on day 1 (d1), d3 and d7 after CRRT; these parameters were also significantly lower than those of the control group on d7. The lac level after oXiris® therapy was significantly lower than that before treatment on d3 and d7 after CRRT. There were no significant differences in the above parameters between the two groups at the other time points. In the oXiris® group, procalcitonin levels decreased on d7, whereas interleukin-6 and tumor necrosis factor levels decreased significantly on d3 and d7 after treatment.

CONCLUSION

CRRT with oXiris® hemofilter may improve hemodynamics by reducing inflammatory mediators and playing a role in shortening the resuscitation period and decreasing total fluid balance in the resuscitation phases.

Keywords: Hematological malignancy; Septic shock; oXiris® hemofilter; Blood purification; Fluid balance

Core tip: oXiris® is a high permeability polyacrylonitrile-based membrane with enhanced endotoxic blood adsorption and cytokine removal; it can be used either in continuous venovenous hemofiltration or continuous venovenous hemodiafiltration. In this study, we explored its effects of shortening the resuscitation time and modifying the host response by reducing levels of inflammatory mediators.