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Zhou J, Li H, Zhang L, Chen G, Wang G, Zhu H, Hao Y, Wu G. Removal of inflammatory factors and prognosis of patients with septic shock complicated with acute kidney injury by hemodiafiltration combined with HA330-II hemoperfusion. Ther Apher Dial 2024; 28:460-466. [PMID: 38317412 DOI: 10.1111/1744-9987.14108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION To explore the effect of CRRT using CVVHDF + HP on the removal of inflammatory mediators in patients with septic shock complicated with AKI. METHODS A total of 20 patients between January 1, 2018, and December 31, 2021, were included. The patients were randomly divided into the treatment group (CVVHDF + HP) and the control group (CVVHDF). Changes in inflammatory factors, including IL-1β, IL-6, IL-8, TNF-α, PCT, and CRP were compared. Other observed measures were also analyzed, for example, Lac, Scr, BUN, SOFA, and norepinephrine (NE) dosage. The clinical outcomes of both groups were followed up for 28 days. RESULTS The IL-6 and PCT levels in the treatment group were significantly lower (p = 0.005, 0.007). Although the IL-1β, TNFα, and CRP levels in the treatment group decreased, there were no statistical differences (p > 0.05). There were significant differences in Lac, SOFA, and NE dosage levels between both groups (p = 0.023, 0.01, 0.023). Survival analysis showed that the 28-day survival rate was significantly higher in the treatment group. CONCLUSION CRRT using CVVHDF+HP can effectively remove inflammatory factors and improve the prognosis of patients.
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Affiliation(s)
- Juan Zhou
- Department of ICU, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Haopeng Li
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Zhang
- Department of ICU, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guangjian Chen
- Department of ICU, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gang Wang
- Department of ICU, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - HuiHui Zhu
- Department of ICU, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingxin Hao
- Department of ICU, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gang Wu
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Chen S, Bao J, Hu Z, Liu X, Cheng S, Zhao W, Zhao C. Porous Microspheres as Pathogen Traps for Sepsis Therapy: Capturing Active Pathogens and Alleviating Inflammatory Reactions. ACS Appl Mater Interfaces 2024. [PMID: 38682663 DOI: 10.1021/acsami.4c01270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Sepsis is a systemic inflammatory response syndrome caused by pathogen infection, while the current antibiotics mainly utilized in clinical practice to combat infection result in the release of pathogen-associated molecular patterns (PAMPs) in the body. Herein, we provide an innovative strategy for controlling sepsis, namely, capturing active pathogens by means of extracorporeal blood purification. Carbon nanotubes (CNTs) were modified with dimethyldiallylammonium chloride (DDA) through γ-ray irradiation-induced graft polymerization to confer a positive charge. Then, CNT-DDAs are blended with polyurethane (PU) to prepare porous microspheres using the electro-spraying method. The obtained microspheres with a pore diameter of 2 μm served as pathogen traps and are termed as PU-CNT-DDA microspheres. Even at a high flow rate of 50 mL·min-1, the capture efficiencies of the PU-CNT-DDAs for Escherichia coli and Staphylococcus aureus remained 94.7% and 98.8%, respectively. This approach circumvents pathogen lysis and mortality, significantly curtails the release of PAMPs, and hampers the production of pro-inflammatory cytokines. Therefore, hemoperfusion using porous PU-CNT-DDAs as pathogen traps to capture active pathogens and alleviate inflammation opens a new route for sepsis therapy.
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Affiliation(s)
- Shifan Chen
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | - Jianxu Bao
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | - Zhen Hu
- Radiation Chemistry Department, Sichuan Institute of Atomic Energy, Chengdu, Sichuan 610101, PR China
| | - Xianda Liu
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | - Shengjun Cheng
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | - Weifeng Zhao
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
- Med-X Center for Materials, Sichuan University, Chengdu 610041, China
| | - Changsheng Zhao
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
- Med-X Center for Materials, Sichuan University, Chengdu 610041, China
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Padilla-Guzmán A, Prado OL, Ballesteros D, Rivera V, Bravo Y, Murillo L, Narváez S, Forero JM. A hospital management algorithm for acute poisoning by Paraquat® in a pediatric population, a series of cases. Biomedica 2024; 44:16-34. [PMID: 38648344 DOI: 10.7705/biomedica.7024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 02/02/2024] [Indexed: 04/25/2024]
Abstract
Paraquat®, or N,N′-dimethyl-4,4′-bipyridinium dichloride, is a bipyridyl compound used as a non-selective herbicide and desiccant that can cause acute poisoning through all routes of exposure. There is no known antidote, and the available treatments are based on avoiding its absorption and timely removing it, in adults and children. We describe a case series of 14 pediatric patients from the department of Cauca, Colombia, with acute intoxication after oral intake of paraquat. Patients were referred to a medium-high complexity hospital in southwestern Colombia and treated according to an institutional protocol for acute paraquat poisoning. Acute paraquat poisoning after oral ingestion is associated with a high mortality rate, even with timely medical attention, as the compound has no known antidote and quickly reaches systemic concentrations for fulminant poisoning. Based on the available literature, our center has proposed a clinical protocol including early standard management, immunosuppressive and antioxidant treatments, and systemic removal techniques. This protocol suggests an adequate approach to acute paraquat poisoning in the pediatric population.
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Affiliation(s)
| | - Olga L Prado
- Nefrología y Cuidado Intensivo Pediátrico, Hospital Universitario San José, Popayán, Colombia
| | - David Ballesteros
- Nefrología y Cuidado Intensivo Pediátrico, Hospital Universitario San José, Popayán, Colombia
| | - Viviana Rivera
- Nefrología y Cuidado Intensivo Pediátrico, Hospital Universitario San José, Popayán, Colombia
| | - Yessica Bravo
- Nefrología y Cuidado Intensivo Pediátrico, Hospital Universitario San José, Popayán, Colombia
| | - Luisa Murillo
- Nefrología y Cuidado Intensivo Pediátrico, Hospital Universitario San José, Popayán, Colombia
| | - Sandra Narváez
- Nefrología y Cuidado Intensivo Pediátrico, Hospital Universitario San José, Popayán, Colombia
| | - Jessica M Forero
- Servicio de Nefrología Pediátrica, Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
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Du Y, Chen M, Wang B, Chai Y, Wang L, Li N, Zhang Y, Liu Z, Guo C, Jiang X, Ma B, Wang Z, Tian Z, Ou L. TiO 2/Polystyrene Nanocomposite Antibacterial Material as a Hemoperfusion Adsorbent for Efficient Bilirubin Removal and Prevention of Bacterial Infection. ACS Biomater Sci Eng 2024; 10:1494-1506. [PMID: 38414275 DOI: 10.1021/acsbiomaterials.3c01854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
The use of hemoperfusion adsorbents for the removal of bilirubin in patients with liver failure has become a critical treatment. However, the insufficient clearance of bilirubin and the possibility of bacterial infection during hemoperfusion limit the application. In this work, we designed a novel antibacterial bilirubin adsorbent (PSVT) through the suspension polymerization reaction between double-bond functionalized TiO2 nanoparticles and styrene. PSVT showed an excellent bilirubin adsorption ability and antibacterial performance, ensuring efficient clearance of bilirubin in liver failure patients during hemoperfusion and preventing bacterial infection. The experimental results indicated that TiO2 was uniformly dispersed in the microspheres, which improved the mesoporous structure and increased the specific surface area. Composite adsorbent PSVT showed an exceptional bilirubin adsorption capacity, with the maximum adsorption capacity reaching 24.3 mg/g. In addition, the introduction of TiO2 endowed PSVT with excellent antibacterial ability; the ultimate antibacterial rates against Escherichia coli and Staphylococcus aureus reached 97.31 and 96.47%, respectively. In summary, PSVT served as a novel antibacterial bilirubin adsorbent with excellent bilirubin clearance capacity and antibacterial performance, providing excellent application prospects for treating liver failure patients.
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Affiliation(s)
- Yunzheng Du
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Mengya Chen
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Biao Wang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Yamin Chai
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
- General Hospital Tianjin Medical University, Tianjin 300052, China
| | - Lichun Wang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
- School of Environmental Science and Engineering, Huazhong University of Science and Technology, Wuhan 430074, P. R. China
| | - Nan Li
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Yanjia Zhang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Zhuang Liu
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Chen Guo
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Xinbang Jiang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Boya Ma
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Zimeng Wang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Ziying Tian
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Lailiang Ou
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
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Ioannou ADF, Tai C, Labato MA, Butty EM. Retrospective evaluation of 22 dogs with leptospirosis treated with extracorporeal renal replacement therapies (2018-2021). J Vet Intern Med 2024; 38:1051-1059. [PMID: 38334229 PMCID: PMC10937474 DOI: 10.1111/jvim.16998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Outcomes of dogs with acute kidney injury secondary to leptospirosis (AKI-L) treated using renal replacement therapies (RRT) are poorly characterized. HYPOTHESIS/OBJECTIVES Describe survival to discharge, short (≤30 days) and long-term (≥6 months) outcomes of AKI-L dogs receiving RRT and determine if there is a significant difference in maximum blood urea nitrogen (maxBUN), maximum creatinine (maxCr), maximum bilirubin (maxBili) and the number of body systems affected between survivors and non-survivors. ANIMALS Twenty-two client-owned dogs with AKI-L receiving RRT. METHODS Retrospective medical record review of dogs with AKI-L that received RRT between 2018 and 2021. RESULTS Sixteen of 22 (73%) dogs survived to discharge. Of the survivors, 13 (81%) were alive >30 days from discharge and 12 (75%) were alive at 6 months from discharge. Factors significantly higher in non-survivors included number of body systems affected (survivors: 1 (19%), 2 (50%), 3 (25%) and 4 (6%) vs non-survivors: 3 (33.3%), and 4 (66.7%); P = .01) and median maxBili (survivors: 1.9 mg/dL; range, 0.1-41.6 vs non-survivors: 21.0 mg/dL; range, 12.3-38.9; P = .02). There was no significant difference in median maxBUN (survivors: 153.0 mg/dL; range, 67-257 vs non-survivors: 185.5 mg/dL; range, 102-218; P = .44) and median maxCr (survivors: 9.8 mg/dL; range, 6.2-15.9 vs non-survivors: 9.8 mg/dL; range, 8.4-13.5; P = .69) between survivors and non-survivors. CONCLUSIONS AND CLINICAL IMPORTANCE Regardless of azotemia severity, dogs with AKI-L receiving RRT have a good survival rate to discharge. The number of body systems affected and hyperbilirubinemia might be associated with worse outcomes.
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Affiliation(s)
- Antonia Da Fonseca Ioannou
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | - Carolyn Tai
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | - Mary Anna Labato
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | - Emmanuelle M. Butty
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
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Her J, Gordon D, Riggs A, Venner L, Cooper E, Langston C. Successful treatment of a severe 5-hydroxytrytophan intoxication using carbon hemoperfusion, hemodiafiltration, and mechanical ventilation in a dog. J Vet Emerg Crit Care (San Antonio) 2024; 34:186-192. [PMID: 38407445 DOI: 10.1111/vec.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/22/2022] [Accepted: 12/10/2022] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To describe the successful use of carbon hemoperfusion and hemodiafiltration in combination with mechanical ventilation (MV) to treat a severe intoxication of 5-hydroxytryptophan (5-HTP) in a dog. CASE SUMMARY A dog ingested a minimum of 550 mg/kg of extended-release 5-HTP, resulting in serotonin syndrome that progressed to a comatose state and severe hypoventilation requiring MV. Extracorporeal carbon hemoperfusion coupled with hemodiafiltration was performed to remove 5-HTP from this patient. A carbon hemoperfusion cartridge was placed in series upstream in the extracorporeal circuit from the hemodialyzer. A total of 46.5 L of blood (4.89 L/kg) was processed during a 4.85-hour treatment. Serial plasma samples were obtained at 0, 60, 90, and 150 minutes during the session and 14 hours after the session. These samples were later analyzed for 5-HTP and serotonin concentrations. The extraction ratio of 5-HTP was 93.6%-98.9% through the carbon filter. The dog was weaned from MV within 8 hours after extracorporeal therapy and, after a full recovery, was successfully discharged. NEW OR UNIQUE INFORMATION PROVIDED Despite an extensive review of the available literature, this appears to be the first reported case of using a carbon hemoperfusion, hemodiafiltration, and MV to treat severe serotonin syndrome secondary to 5-HTP intoxication in a dog. The combination of carbon hemoperfusion and hemodiafiltration can significantly reduce plasma 5-HTP concentrations after acute intoxication and may serve to decrease morbidity and mortality in patients with severe intoxication.
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Affiliation(s)
- Jiwoong Her
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Daniel Gordon
- Colorado Animal Specialty & Emergency, Boulder, Colorado, USA
| | - Alexandra Riggs
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Laura Venner
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Edward Cooper
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Catherine Langston
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
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Seffer MT, Meyer TM, Borchina DN, Kielstein JT, Schmidt JJ. Using the Seraph® 100 Microbind® Affinity blood filter under slow flow conditions through 18 G and 16 G central lines. J Vasc Access 2024:11297298241234073. [PMID: 38415617 DOI: 10.1177/11297298241234073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION The Seraph® 100 Microbind® Affinity blood filter (Seraph® 100) has been in use since 2019 for the treatment of fulminant or difficult to treat blood stream infections as an adjunct to pharmacotherapy. In 2020 the device received emergency use authorization by the US Food and Drug Administration for the treatment of critically ill COVID-19 patients with confirmed or imminent respiratory failure. Results of an international registry showed that the Seraph® 100 was operated under blood flow rates of 100-350 mL/min. As those conditions require a large bore central line, a dialysis catheter is currently considered indispensable to operate the Seraph® 100. The use of smaller catheter lumina has neither been evaluated in vitro nor in vivo. METHODS In vitro pressure data before and after the Seraph® 100 at various blood pump rates (prepump line 16 G, postpump line 18 G) with saline and human plasma were obtained. Further, anecdotal flow and pressure data of two patients treated with the Seraph® 100 for a COVID-19 infection are reported. RESULTS At a pump speed of 50 mL/min pre-Seraph® pressure using saline was -70 [-70 to -60] mm Hg. In comparison, using plasma pre-Seraph® pressure was lower at -120 [-120 to -105] mm Hg; p < 0.001 (t-test). The post-Seraph® pressure at 50 mL/min using saline of 120 [110-130] mm Hg was not different from plasma at 130 [120-140] mm Hg, p = 0.152 (t-test). Blood flow rates of 50 mL/min did not lead to preAP levels below -250 mm Hg in the two clinical cases. CONCLUSION Seraph® 100 blood flow rate of 50 mL/min may be achieved using low flow vascular access, allowing to treat a blood volume 72 L in 24 h.
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Affiliation(s)
- Malin-Theres Seffer
- Medical Clinic V, Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Torsten M Meyer
- Medical Clinic V, Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Dan-Nicolae Borchina
- Medical Clinic V, Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Jan T Kielstein
- Medical Clinic V, Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Julius J Schmidt
- Deparment of Nephrology and Hypertension, Hannover Medical School, Hannover, Niedersachsen, Germany
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Yu ZX, Pi Y, Chen MK, Dong DJ, Gu Q. Clozapine-Induced Severe Toxicity: Exploring the Pharmacokinetic Profile of Clozapine and Its Significance in Hemodynamic Instability - A Case Report. Int Med Case Rep J 2024; 17:111-120. [PMID: 38348428 PMCID: PMC10860498 DOI: 10.2147/imcrj.s444685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
Hemodynamic instability in patients with clozapine intoxication can indirectly reflect the serum concentration of clozapine.We have described a case of a 32-year-old pregnant woman who developed life-threatening clozapine toxicity at 28 weeks of gestation. The levels of clozapine and norclozapine in the serum were high. We initiated hemoperfusion(HP) and other detoxification therapies to remove the drug. The patient had severely dilated peripheral blood vessels, which led to cardiac symptoms such as fatal hypotension and uncontrollable tachycardia, resulting in very high cardiac output and elevated Central venous oxygen saturation (ScvO2). Pharmacological intervention significantly improved the hemodynamics.In light of our observations in the ongoing case, we posit that evaluating hemodynamic parameters before and after blood detoxification could serve as a valuable means to gauge effectiveness and provide guidance for treatment.
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Affiliation(s)
- Zhu-Xi Yu
- Department of Critical Care Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 21008, People’s Republic of China
| | - Yang Pi
- Department of Critical Care Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 21008, People’s Republic of China
| | - Mei-Kai Chen
- Department of Critical Care Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 21008, People’s Republic of China
| | - Dan-Jiang Dong
- Department of Critical Care Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 21008, People’s Republic of China
| | - Qin Gu
- Department of Critical Care Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 21008, People’s Republic of China
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Lovrić D, Pašalić M, Križanac S, Kovačić K, Skorić B, Jurin H, Miličić D, Premužić V. The addition of Cytosorb in patients on VA-ECMO improves urinary output and ICU survival. Ther Apher Dial 2024; 28:103-111. [PMID: 37697687 DOI: 10.1111/1744-9987.14064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 03/18/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the efficiency of CytoSorb adsorber in patients presenting with cardiogenic shock and treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). METHODS Sixteen patients put on VA ECMO due to cardiogenic shock were included, stratified according to the use of Cytosorb adsorber in the first 24 h and compared across different clinical outcomes. RESULTS Significantly lower vasopressor doses were required among patients treated with Cytosorb at the initiation and before weaning from ECMO. Furthermore, these patients showed significantly higher urine output before weaning and lower lactate levels during the extracorporeal support. Finally, the mortality rate was lower among the Cytosorb therapy group (22.2% vs 57.1%). CONCLUSION While a decrease in vasopressor doses was already associated with CytoSorb use, this is the first study showing an increase in urinary output and a trend towards better survival among patients on VA ECMO treated with CytoSorb.
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Affiliation(s)
- Daniel Lovrić
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marijan Pašalić
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Karla Kovačić
- Emergency Medicine Institute of Koprivnica-Križevci County, Koprivnica, Croatia
| | - Boško Skorić
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Hrvoje Jurin
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Davor Miličić
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Vedran Premužić
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Zagreb, Croatia
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Barriga-Moreno AP, Lozano-Sanchez M, Barón-Alvarez RA, Cordoba JP, Aroca-Martinez G, Dianda D, Gonzalez-Torres H, Musso CG. Mortality Rate and Acute Kidney Injury Prevalence Reduction in COVID-19 Critical Patients Treated with Hemoperfusion. Indian J Nephrol 2024; 34:56-58. [PMID: 38645920 PMCID: PMC11003593 DOI: 10.4103/ijn.ijn_175_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/31/2023] [Indexed: 04/23/2024] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) induces organic damage mainly through the patient's immune overreaction. Hemoperfusion (HPF) can remove inflammatory cytokines and can reduce the negative effects of cytokine storm in COVID-19. We compared the mortality rate, inflammatory response, and acute kidney injury (AKI) prevalence among patients suffering from respiratory insufficiency secondary to COVID-19 treated with and without HPF with HA330 cartridge. Methods Mortality rate, serum creatinine, and ferritin values were compared between patients suffering from respiratory insufficiency secondary to COVID-19 who received conventional treatment and another group of patients who additionally received four sessions of HPF with HA330. Results Of 116 patients suffering from acute respiratory insufficiency secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), one group (n: 84) received support treatment and the other group (n: 32) additionally received HPF with HA330 cartridge. Both groups had no renal disease and similar age and comorbidities at admission, except for obesity and mechanical ventilation requirement, which were significantly higher in the HPF group. Mortality rate (61% vs. 31%, P: 0.008), serum creatinine (1.4 vs. 0.5 mg/dl, P < 0.001), and post-HPF serum ferritin (2868 vs. 1675, P < 0.001) were significantly lower in the HPF group. Conclusion Mortality rate, serum ferritin, and AKI were significantly reduced in critical COVID-19 patients who received HPF with HA330 cartridge than in those who did not receive it. These results were obtained despite the HPF group risk factors, such as obesity and mechanical ventilation, worsening its prognosis.
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Affiliation(s)
| | | | | | - Juan P. Cordoba
- Nephrology Division, Clínica de la Costa, Barranquilla, Colombia
| | - Gustavo Aroca-Martinez
- Nephrology Division, Clínica de la Costa, Barranquilla, Colombia
- Universidad del Norte, Barranquilla, Colombia
| | - Daniela Dianda
- Nephrology Division, Clínica de la Costa, Barranquilla, Colombia
| | | | - Carlos G. Musso
- Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia
- Research Departament, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Liu R, Xiao L, Hu Y, Yan Q, Liu X. Rescue strategies for valproic acid overdose poisoning: Case series and literature review. Clin Case Rep 2024; 12:e8367. [PMID: 38161627 PMCID: PMC10753133 DOI: 10.1002/ccr3.8367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/25/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Valproic acid (VPA) is a wide-ranging anti-epileptic medication that primarily affects bipolar disorder, mania, and migraine. The leading causes of mortality associated with acute poisoning from VPA are nervous system toxicity, drug-induced shock due to encephalopathy from hyperammonemia, as well as acute liver and kidney failure, and respiratory depression that contribute to hemodynamic instability. Treatment of acute VPA poisoning primarily involves in vitro elimination methods, including hemoperfusion (HP), hemodialysis, and hemofiltration, as well as drug remedies such as L-carnitine and meropenem. Nonetheless, there are conflicting opinions regarding drug usage. This article details the three cases of acute poisoning from VPA. The fundamental approach to treatment employs HP assisted by blood concentration monitoring to alleviate shock and stabilize hemodynamics. This investigation presents guidance for the treatment and management of acute poisoning with VPA in clinical settings.
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Affiliation(s)
- Renzhu Liu
- Department of Clinical PharmacyXiangtan Central HospitalXiangtanChina
- Zhou Honghao Research Institute XiangtanXiangtan Central HospitalXiangtanChina
| | - Lu Xiao
- Department of Children Health CareXiangtan Maternal and Child Care Service CentreXiangtanChina
| | - Yixiang Hu
- Department of Clinical PharmacyXiangtan Central HospitalXiangtanChina
- Zhou Honghao Research Institute XiangtanXiangtan Central HospitalXiangtanChina
| | - Qingzi Yan
- Department of Clinical PharmacyXiangtan Central HospitalXiangtanChina
- Zhou Honghao Research Institute XiangtanXiangtan Central HospitalXiangtanChina
| | - Xiang Liu
- Department of Clinical PharmacyXiangtan Central HospitalXiangtanChina
- Zhou Honghao Research Institute XiangtanXiangtan Central HospitalXiangtanChina
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12
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Li Q, Zhu Y, Li Y, Yang J, Bao Z, Tian S, Wang X, Zhang L. Reusable Zwitterionic Porous Organic Polymers for Bilirubin Removal in Serum. ACS Appl Mater Interfaces 2023. [PMID: 38048490 DOI: 10.1021/acsami.3c11824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Herein, we report a straightforward strategy to construct reusable, hemocompatible, and highly efficient bilirubin adsorbents by installing zwitterionic modules into a porous organic polymer (POP) for hemoperfusion application. Three types of zwitterions with different amounts are used to evaluate their impacts on the characteristics of POPs, including carboxybetaine methacrylate (CB), sulfobetaine methacrylate (SB), and 2-methacryloyloxyethyl phosphorylcholine (MPC). Results show that zwitterions can improve hemocompatibility, hydrophilicity, and bilirubin uptake of the POP. Among all zwitterionic POPs, POP-CB-40% exhibits the best bilirubin uptake, ∼46.5 times enhancement compared with the non-zwitterionic POP in 100% serum. This enhancement can be attributed to the improved hydrophilicity and protein resistance ability in biological solutions. More importantly, the reusability test shows that POP-CB-40% maintains ∼99% of bilirubin uptake capacity at fifth recycling in 100% serum. Findings in this work provide a guideline for the design of biocompatible and efficient POP-based bilirubin adsorbents for hemoperfusion therapy.
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Affiliation(s)
- Qingsi Li
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), Tianjin University, Tianjin 300350, China
| | - Yingnan Zhu
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Center for Drug Safety Evaluation and Research, Zhengzhou University, Zhengzhou 450001, China
| | - Yongjian Li
- Cardiovascular Department, Tianjin Nankai Hospital, No. 122, Sanwei Road, Nankai District, Tianjin 300102, China
| | - Jing Yang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), Tianjin University, Tianjin 300350, China
| | - Zhun Bao
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), Tianjin University, Tianjin 300350, China
| | - Shu Tian
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), Tianjin University, Tianjin 300350, China
| | - Xiaodong Wang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), Tianjin University, Tianjin 300350, China
| | - Lei Zhang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), Tianjin University, Tianjin 300350, China
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Sun Y, Xing L, Luo J, Yu MT, Wang XJ, Wang Y, Zhou TJ, Jiang HL. A Pro-Metastatic Derivatives Eliminator for In Vivo Dual-Removal of Circulating Tumor Cells and Tumor-Derived Exosomes Impedes their Biodistribution into Distant Organs. Adv Sci (Weinh) 2023; 10:e2304287. [PMID: 37867235 DOI: 10.1002/advs.202304287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/24/2023] [Indexed: 10/24/2023]
Abstract
Circulating tumor cells (CTCs) and tumor-derived exosomes (TDEs) play an irreplaceable role in the metastatic cascade and preventing them from reaching distant organs via blood circulation helps to reduce the probability of cancer recurrence and metastasis. However, technologies that can simultaneously prevent CTCs and TDEs from reaching distant organs have not been thoroughly developed until now. Here, inspired by hemoperfusion, a pro-metastatic derivative eliminator (PMDE) is developed for the removal of both CTCs and TDEs from the peripheral blood, which also inhibits their biodistribution in distant organs. This device is designed with a dual antibody-modified immunosorbent filled into a capture column that draws peripheral blood out of the body to flow through the column to specifically capture CTCs and TDEs, followed by retransfusing the purified blood into the body. The PMDE can efficiently remove CTCs and TDEs from the peripheral blood and has excellent biocompatibility. Interestingly, the PMDE device can significantly inhibit the biodistribution of CTCs and TDEs in the lung and liver by scavenging them. This work provides a new perspective on anti-metastatic therapy and has broad prospects in clinical applications to prevent metastasis and recurrence.
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Affiliation(s)
- Ying Sun
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, 210009, China
| | - Lei Xing
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, 210009, China
- Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, China Pharmaceutical University, Nanjing, 210009, China
- Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases, China Pharmaceutical University, Nanjing, 210009, China
| | - Jun Luo
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, 210009, China
| | - Ming-Tao Yu
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, 210009, China
| | - Xiao-Jie Wang
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, 210009, China
| | - Yi Wang
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, 210009, China
| | - Tian-Jiao Zhou
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, 210009, China
| | - Hu-Lin Jiang
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, 210009, China
- Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, China Pharmaceutical University, Nanjing, 210009, China
- Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases, China Pharmaceutical University, Nanjing, 210009, China
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Heymann M, Schorer R, Putzu A. The Effect of CytoSorb on Inflammatory Markers in Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Crit Care Med 2023; 51:1659-1673. [PMID: 37607074 PMCID: PMC10645103 DOI: 10.1097/ccm.0000000000006007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES The effectiveness of CytoSorb at removing inflammatory mediators in critically ill patients is controversial. DATA SOURCES Electronic databases were searched from inception to May 2023. STUDY SELECTION Randomized controlled trials reporting the effects of CytoSorb therapy on inflammatory parameters in critically ill patients with hyperinflammatory conditions were included. DATA EXTRACTION Two authors screened articles for eligibility, extracted data, and assessed the risk of bias, conflicts of interest, and certainty of evidence (CoE). The primary outcome was interleukin (IL)-6 at 1 day after initiation of the therapy. Secondary outcomes included various inflammatory markers at 1, 2, 3, and 5 days and mortality. Data were pooled if at least three trials reported the outcome of interest. We conducted meta-analyses of the data using a random-effects model. DATA SYNTHESIS Seventeen trials ( n = 855) were included. Fourteen trials were judged to have notable concern about conflicts of interest. Seven trials were performed in medical ICU patients with hyperinflammatory conditions and 10 in complex cardiovascular surgery under cardiopulmonary bypass. Hemoadsorption with CytoSorb was not associated with lower IL-6 at 1 day (mean difference -5.98 [95% CI, -30.44 to 18.48] pg/mL), 2 days, 3 days, or 5 days after initiation of the treatment, as well as the concentration of procalcitionin. The levels of C-reactive protein were not lower with CytoSorb at 1, 2, and 3 days. The use of CytoSorb was associated with higher mortality at latest follow-up (relative risk = 1.22 [95% CI, 1.02-1.45]) and at 30 days. CoE ranged from low to very low. CONCLUSIONS The use of CytoSorb hemoadsorption in a mixed population of critically ill patients with hyperinflammatory conditions does not exhibit a consistent decrease in IL-6 and other inflammatory parameters within the first 5 days of treatment. The significant uncertainty surrounding these findings highlights the need for further investigations.
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Affiliation(s)
- Marc Heymann
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
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15
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Foster JD. Nephrology in Veterinary Medicine. Kidney360 2023; 4:1641-1649. [PMID: 37840194 PMCID: PMC10695652 DOI: 10.34067/kid.0000000000000273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
Veterinary nephrology is a specialized field of veterinary medicine providing a high level of care for animals with all types of kidney disease. Veterinarians complete extensive training to become board-certified in veterinary nephrology-urology. Companion animal nephrology is the most advanced field; however, all species are afflicted by a variety of renal disorders. Most naturally occurring animal kidney diseases have similar disorders found in people; where veterinary research is lacking, clinical management is often modified from standard of care in people. Veterinarians have become adept at scaling down procedures to safely perform them on dogs and cats weighing only a few kilograms. Advanced diagnostics (renal biopsy, cystoscopy, fluoroscopic studies, etc. ) and therapeutics (renal replacement therapy, interventional endourology, etc. ) are commonly performed within the practice of veterinary nephrology-urology. Collaboration between veterinary and human nephrologists may advance both disciplines and improve care for people and animals alike.
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16
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Leber B, Liebchen U, Rohrhofer L, Weber J, Klaus T, Scheier J, Sucher R, Stiegler P. Pharmacokinetics of immunosuppressive agents during hemoperfusion in a sheep model. Front Med (Lausanne) 2023; 10:1258661. [PMID: 37928476 PMCID: PMC10623319 DOI: 10.3389/fmed.2023.1258661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Hemoadsorption shows promising signals in organ preservation and post lung transplantation. However, its potential impact on the pharmacokinetics of immunosuppressant drugs (ID) is still unknown. Methods In this interventional study, CytoSorb® hemoperfusion was tested in healthy sheep (n = 5) against a sham extracorporeal circuit (n = 3). Seven different ID (tacrolimus (TAC), cyclosporin A (CYA), mycophenolate mofetil (MMF), everolimus (EVER), basiliximab (BAS), methylprednisolone (MP) and prednisolone (PRED)) were administered in clinically relevant doses and combinations. Their levels were measured repeatedly in blood samples from the extracorporeal circulation over 6 h following administration. Population pharmacokinetic modeling analysis (NONMEM® 7.5) was performed. Results Negligible clearance was observed for PRED and BAS. For all other substances, a saturable adsorption sub-model with linear decrease of the adsorption effect over the adsorbed amount best described the measured concentrations. The maximum absolute adsorbed amounts (95% CI) for TAC, CYA, MMF, EVER, and MP were 0.040 (0.028-0.053), 1.15 (0.39-1.91), 4.17 (2.00-6.35), 0.0163 (0.007-0.026), and 53.4 mg (20.9-85.9), respectively, indicating an adsorption of less than 5% of the daily administered dosages for all investigated substances. Discussion In this large animal model, CytoSorb® hemoperfusion appears to have a limited effect on the clearance of tested ID.
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Affiliation(s)
- Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Uwe Liebchen
- Department of Anesthesiology, LMU Hospital, Munich, Germany
| | - Lisa Rohrhofer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Jennifer Weber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | | | - Robert Sucher
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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17
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El Gabry M, Arends S, Shehada SE, Lahner H, Kamler M, Wendt D, Spetsotaki K. Hedinger Syndrome-Lessons Learnt: A Single-Center Experience. J Cardiovasc Dev Dis 2023; 10:413. [PMID: 37887860 PMCID: PMC10607344 DOI: 10.3390/jcdd10100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Hedinger syndrome (HS) or carcinoid heart disease (CD) is a rare and challenging manifestation of malignant neuroendocrine tumours (NETs) involving the heart. We aimed to report our experience with surgical strategies and midterm results in HS patients. METHODS Eleven patients (58 ± 11 (range 41 to 79 years); 5 females) with HS who underwent cardiac surgery in our department between 07/2005 and 05/2023 were analysed. RESULTS All patients showed a New York Heart Association (NYHA) class III-IV and in all the tricuspid valve (TV) was involved. Four patients received a TV replacement, and three TV reconstruction. Recently, to preserve the geometry and function of the compromised right ventricle (RV), we have applied the TV "bio-prosthesis in native-valve" implantation technique with the preservation of the valve apparatus (tricuspid valve implantation: TVI) in four cases. Concomitant procedures included pulmonary valve replacement in four, pulmonary implantation in one, and aortic valve replacement in three cases. To treat RV failure, we adapted a combined TandemHeart®-CytoSorb® haemoperfusion strategy in Patient #10 and venoarterial extracorporeal membrane oxygenation (V-A ECMO) support avoidance, after experiencing an ECMO-induced carcinoid-storm-related death in Patient #8. Mortality at 30 days was 18% (2/11). The median follow up was 2 ± 2.1 years (range 1 month to 6 years) with an overall mortality during the follow-up period of 72.7% (8/11). CONCLUSIONS HS surgery, despite being a high-risk procedure, can efficiently prolong survival, and represents a safe and feasible procedure. However, patient selection seems to be crucial. Further follow up and larger cohorts are needed.
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Affiliation(s)
- Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, 45147 Essen, Germany; (M.E.G.); (M.K.); (D.W.)
| | - Sven Arends
- Department for Anesthesiology and Intensive Care Medicine, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, 45147 Essen, Germany; (M.E.G.); (M.K.); (D.W.)
| | - Harald Lahner
- Department of Endocrinology and Metabolism, University Hospitals Duisburg-Essen, 45147 Essen, Germany;
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, 45147 Essen, Germany; (M.E.G.); (M.K.); (D.W.)
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, 45147 Essen, Germany; (M.E.G.); (M.K.); (D.W.)
- CytoSorbents Europe GmbH, 12587 Berlin, Germany
| | - Konstantina Spetsotaki
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, 45147 Essen, Germany; (M.E.G.); (M.K.); (D.W.)
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18
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Li M, Chen M, Yang F, Qin R, Yang Q, Ren H, Liu H, Yang P. Protein/Polysaccharide Composite toward Multi-in-One Toxin Removal in Blood with Self-Anticoagulation and Biocompatibility. Adv Healthc Mater 2023; 12:e2300999. [PMID: 37334878 DOI: 10.1002/adhm.202300999] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/02/2023] [Indexed: 06/21/2023]
Abstract
Biocompatible adsorbents play an essential role in hemoperfusion. Nevertheless, there are no hemoperfusion adsorbents that can simultaneously remove small and medium toxins, including bilirubin, urea, phosphor, heavy metals, and antibiotics. This bottleneck significantly impedes the miniaturization and portability of hemoperfusion materials and devices. Herein, a biocompatible protein-polysaccharide complex is reported that exhibits "multi-in-one" removal efficacy for liver and kidney metabolism wastes, toxic metal ions, and antibiotics. Through electrostatic interactions and polysaccharide-mediated coacervation, adsorbents can be prepared by simply mixing lysozyme (LZ) and sodium alginate (SA) together in seconds. The LZ/SA absorbent presented high adsorption capacities for bilirubin, urea, and Hg2+ of up to 468, 331, and 497 mg g-1 , respectively, and the excellent anti-protein adsorption endowed LZ/SA with a record-high adsorption capacity for bilirubin in the interference of serum albumin to simulate the physiological environment. The LZ/SA adsorbent also has effective adsorption capacity for heavy metals (Pb2+ , Cu2+ , Cr3+ , and Cd2+ ) and multiple antibiotics (terramycin, tetracycline, enrofloxacin, norfloxacin, roxithromycin, erythromycin, sulfapyrimidine, and sulfamethoxazole). Various adsorption functional groups exposed on the adsorbent surface significantly contribute to the excellent adsorption capacity. This fully bio-derived protein/alginate-based hemoperfusion adsorbent has great application prospects in the treatment of blood-related diseases.
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Affiliation(s)
- Mengjie Li
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- Xi'an Key Laboratory of Polymeric Soft Matter, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- International Joint Research Center on Functional Fiber and Soft Smart Textile, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Mengmeng Chen
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- Xi'an Key Laboratory of Polymeric Soft Matter, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- International Joint Research Center on Functional Fiber and Soft Smart Textile, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Facui Yang
- School of Materials and Chemical Engineering, Xi'an Technological University, Xi'an, 710021, China
| | - Rongrong Qin
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering (IBME), Northwestern Polytechnical University, 127 West Youyi Road, Xi'an, 710072, China
| | - Qingmin Yang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- Xi'an Key Laboratory of Polymeric Soft Matter, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- International Joint Research Center on Functional Fiber and Soft Smart Textile, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Hao Ren
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- Xi'an Key Laboratory of Polymeric Soft Matter, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- International Joint Research Center on Functional Fiber and Soft Smart Textile, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Han Liu
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- Xi'an Key Laboratory of Polymeric Soft Matter, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- International Joint Research Center on Functional Fiber and Soft Smart Textile, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Peng Yang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- Xi'an Key Laboratory of Polymeric Soft Matter, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
- International Joint Research Center on Functional Fiber and Soft Smart Textile, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
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Yavuz T, Orhan S, Rollas K, Toksoy CK, Kazan ED, Bozkurt E, Cosgun İG, Yavasoglu F. Evaluation of clinical features and laboratory findings in critical intensive care unit patients with severe coronavirus disease-19 who underwent extracorporeal cytokine adsorption. Ther Apher Dial 2023; 27:890-897. [PMID: 37177852 DOI: 10.1111/1744-9987.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/03/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
AIM To evaluate the inflammatory parameters and oxygenation in severe coronavirus disease-19 patients who underwent extracorporeal cytokine adsorption (CA). METHODS Patients who underwent extracorporeal CA for cytokine storm were included in the study. The changes in oxygenation, laboratory parameters, and mortality rates were investigated. RESULTS Thirty-six patients were included in the study. The hemoglobin, thrombocyte, and C-reactive protein (CRP) decreased, and PaO2 /FiO2 ratio increased (p < 0.001; p < 0.01; p < 0.001; p = 0.04, respectively). Twelve (33.3%) patients received a single session, 24 (66.6%) received 2 or more sessions. CRP and fibrinogen levels decreased, and PaO2 /FIO2 ratio increased in the single session group (p = 0.04; p = 0.04; p = 0.01, respectively). In the multi-session group, the hemoglobin, platelet, procalcitonin, and CRP levels decreased, and PaO2 /FIO2 ratio increased (p < 0.01; p = 0.02; p = 0.02; p < 0.01; p = 0.01, respectively). Day 15, 30, and 90 mortality rates were 61.1%, 83.3%, and 88.9%. CONCLUSION CA with hemoperfusion reduced CRP and improved oxygenation; however, mortality rates were high.
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Affiliation(s)
- Tunzala Yavuz
- Intensive Care Unit, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, İzmir, Turkey
| | - Semiha Orhan
- Intensive Care Unit, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Kazim Rollas
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, İzmir, Turkey
| | - Cansu Koseoglu Toksoy
- Department of Neurology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Elif Dizen Kazan
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Erhan Bozkurt
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - İbrahim Guven Cosgun
- Department of Chest Diseases, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Filiz Yavasoglu
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Ghannoum M, Roberts DM. Management of Poisonings and Intoxications. Clin J Am Soc Nephrol 2023; 18:1210-1221. [PMID: 37097121 PMCID: PMC10564369 DOI: 10.2215/cjn.0000000000000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/21/2022] [Indexed: 01/22/2023]
Abstract
Poisoning occurs after exposure to any of a number of substances, including medicines, which can result in severe toxicity including death. The nephrologist may be involved in poisonings that cause kidney disease and for targeted treatments. The overall approach to the poisoned patient involves the initial acute resuscitation and performing a risk assessment, whereby the exposure is considered in terms of the anticipated severity and in the context of the patient's status and treatments that may be required. Time-critical interventions such as gastrointestinal decontamination ( e.g. , activated charcoal) and antidotes are administered when indicated. The nephrologist is usually involved when elimination enhancement techniques are required, such as urine alkalinization or extracorporeal treatments. There is increasing data to guide decision making for the use of extracorporeal treatments in the poisoned patient. Principles to consider are clinical indications such as whether severe toxicity is present, anticipated, and/or will persist and whether the poison will be significantly removed by the extracorporeal treatment. Extracorporeal clearance is maximized for low-molecular weight drugs that are water soluble with minimal protein binding (<80%) and low endogenous clearance and volume of distribution. The dosage of some antidotes ( e.g. , N-acetylcysteine, ethanol, fomepizole) should be increased to maintain therapeutic concentrations once the extracorporeal treatment is initiated. To maximize the effect of an extracorporeal treatment, blood and effluent flows should be optimized, the filter with the largest surface area selected, and duration tailored to remove enough poison to reduce toxicity. Intermittent hemodialysis is recommended in most cases when an extracorporeal treatment is required because it is the most efficient, and continuous kidney replacement therapy is prescribed in some circumstances, particularly if intermittent hemodialysis is not readily available.
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Affiliation(s)
- Marc Ghannoum
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, University of Montreal, Montreal, Quebec, Canada, and Department of Nephrology and Hypertension, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Darren M. Roberts
- New South Wales Poisons Information Centre, Sydney Children's Hospitals Network, Westmead, and Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Zeng DH, Chen XH, Li Y, Zhu XY, Wang BL, Ma XG, Cao YL. Clinical and pathological characteristics of acute kidney injury caused by diquat poisoning. Clin Toxicol (Phila) 2023; 61:705-708. [PMID: 37882621 DOI: 10.1080/15563650.2023.2262113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/19/2023] [Indexed: 10/27/2023]
Abstract
Introduction: Diquat poisoning leads to kidney injury, hepatotoxicity, rhabdomyolysis, gastrointestinal hemorrhage, and respiratory failure. Diquat has high mortality and no specific antidote. The pathology of acute kidney injury caused by diquat poisoning has been mainly investigated in animal studies and autopsies, and typically shows renal tubular necrosis. To our knowledge, antemortem renal biopsy has not been reported in humans.Case reports: Two males and one female presented following deliberate diquat self-poisoning. Their main clinical manifestations were abdominal pain, nausea, and emesis. All developed acute kidney injury. Kidney biopsy was performed in two cases which showed acute tubular necrosis with renal interstitial edema and multifocal inflammatory cell infiltration. Treatments given included gastric lavage, catharsis, early hemoperfusion combined with continuous kidney replacement therapy or hemodialysis, administration of glucocorticoids, and antioxidant therapy. All patients survived.Discussion: Despite potentially lethal ingestions three patients survived oral diquat poisoning with intensive supportive care. No clear relationship can be made between any of the therapies given and patient outcome.Conclusions: Kidney biopsy in these patients confirmed proximal renal tubular injury was the major pathological finding although interstitial injury was also present. The role of therapies that address renal pathology requires further study.
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Affiliation(s)
- De-Hui Zeng
- Department of Nephrology, The Third People's Hospital of Longgang District, Shenzhen, China
| | - Xia-Hua Chen
- Department of Nephrology, The Third People's Hospital of Longgang District, Shenzhen, China
| | - Yun Li
- Department of Nephrology, The Third People's Hospital of Longgang District, Shenzhen, China
| | - Xiang-Yang Zhu
- Department of Nephrology, The Third People's Hospital of Longgang District, Shenzhen, China
| | - Ba-Li Wang
- Department of Nephrology, The Third People's Hospital of Longgang District, Shenzhen, China
| | - Xu-Guo Ma
- Department of Nephrology, The Third People's Hospital of Longgang District, Shenzhen, China
| | - Ya-Li Cao
- Department of Nephrology, The Third People's Hospital of Longgang District, Shenzhen, China
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Garcia-Ramos S, Caamaño E, Rodríguez Benítez P, Benito P, Calvo A, Ramos S, Power M, Garutti I, Piñeiro P. Mortality Risk Prediction in Abdominal Septic Shock Treated with Polymyxin-B Hemoperfusion: A Retrospective Cohort Study. J Pers Med 2023; 13:1023. [PMID: 37511635 PMCID: PMC10381630 DOI: 10.3390/jpm13071023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Endotoxin, a component of the cell membrane of gram-negative bacteria, is a trigger for dysregulated inflammatory response in sepsis. Extracorporeal purification of endotoxin, through adsorption with polymyxin B, has been studied as a therapeutic option for sepsis. Previous studies suggest that it could be effective in patients with high endotoxin levels or patients with septic shock of moderate severity. Here, we perform a retrospective, single-centre cohort study of 93 patients suffering from abdominal septic shock treated with polymyxin-B hemoperfusion (PMX-HP) between 2015 and 2020. We compared deceased and surviving patients one month after the intervention using X2 and Mann-Whitney U tests. We assessed the data before and after PMX-HP with a Wilcoxon single-rank test and a multivariate logistic regression analysis. There was a significant reduction of SOFA score in the survivors. The expected mortality using APACHE-II was 59.62%, whereas in our sample, the rate was 40.9%. We found significant differences between expected mortality and real mortality only for the group of patients with an SOFA score between 8 and 13. In conclusion, in patients with abdominal septic shock, the addition of PMX-HP to the standard therapy resulted in lower mortality than expected in the subgroup of patients with intermediate severity of illness.
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Affiliation(s)
- Sergio Garcia-Ramos
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Estrela Caamaño
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | | | - Pilar Benito
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Alberto Calvo
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Silvia Ramos
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Mercedes Power
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Ignacio Garutti
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Patricia Piñeiro
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
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Li W, Wang J, Wang Y, Guan R, Zhao F, Zhang R. Additional hemoperfusion for patients receiving maintenance hemodialysis: a retrospective analysis. Am J Transl Res 2023; 15:4045-4054. [PMID: 37434811 PMCID: PMC10331684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To determine the efficacy of hemodialysis combined with hemoperfusion with acupuncture on calcium-phosphorus metabolism disorder (CPMD) of patients who had received maintenance hemodialysis and its effect on intact parathyroid hormone (iPTH) and nutritional status. METHODS Data from 142 patients who were treated and given maintenance hemodialysis in Baoji People's Hospital from March 2018 to February 2020 were analyzed retrospectively. Patients treated with hemodialysis and acupuncture-moxibustion adjuvant therapy were enrolled into the control group (n=58), while those treated with hemoperfusion in addition to hemodialysis and acupuncture-moxibustion adjuvant therapy were enrolled into the research group (n=84). The two groups were compared in terms of changes in iPTH, calcium-phosphorus product, serum calcium (Ca), serum phosphorus (P), β2 microglobulin (β2-MG), serum albumin (Alb), creatinine (Scr) and urea nitrogen (BUN). The clinical efficacy in the two groups was compared after therapy, and the two groups were also compared in the improvement of immune function-related indexes (IgG and IgM) and the changes of nutrition-related indexes (Alb, prealbumin (PA) and hemoglobin (Hb)) before and after treatment. A risk prediction model was constructed based on LASSO regression to evaluate the predictive value of the risk score for efficacy of patients. RESULTS After treatment, the research group presented significantly lower levels of P, iPTH, and calcium-phosphorus product than the control group, but a significantly higher Ca level than the control group (all P<0.05). In addition, after treatment, the research group showed significantly lower levels of β2-MG, Scr and BUN but a higher Alb level than the control group (all P<0.05). After treatment, the research group had a greater improvement in immune function-related indexes (IgG and IgM) than the control group (all P<0.05), while the control group had significantly decreased Alb, PA and Hb after treatment (all P<0.05), but the levels of these in the research group did not change greatly (all P>0.05). Risk scoring formula was constructed: risk score = (dialysis time * 0.057123881) + (Ca * -0.100413548) + (P * 0.100419363) + (calcium and phosphorus product * 0.03872268) + (iPTH * 0.000358779). According to inter-group comparison of risk score, the Improvement group got a lower risk score than the Non-improvement group (P<0.0001). Moreover, according to ROC curve-based analysis, the area under the curve of risk score in predicting the efficacy of patients was 0.991. CONCLUSION Hemodialysis combined with acupuncture and blood perfusion can control the immune regulation by increasing the blood calcium content without affecting nutritional status, but it has no significant effect on the efficacy in patients.
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Affiliation(s)
- Wendong Li
- Department of Nephrology, Baoji People’s HospitalBaoji 721000, Shaanxi, China
| | - Jing Wang
- Department of Nephrology, Baoji People’s HospitalBaoji 721000, Shaanxi, China
| | - Yanqin Wang
- Department of Nephrology, Baoji People’s HospitalBaoji 721000, Shaanxi, China
| | - Rui Guan
- Traditional Chinese Medicine Department, Baoji Maternal and Child Health HospitalBaoji 721000, Shaanxi, China
| | - Fan Zhao
- Traditional Chinese Medicine Department, Baoji Maternal and Child Health HospitalBaoji 721000, Shaanxi, China
| | - Rongrong Zhang
- Traditional Chinese Medicine Department, Baoji Maternal and Child Health HospitalBaoji 721000, Shaanxi, China
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24
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Rey S, Kulabukhov VM, Popov A, Nikitina O, Berdnikov G, Magomedov M, Kim T, Masolitin S, Ignatenko O, Krotenko N, Marysheva A, Chaus N, Ohinko L, Mendibaev M, Chumachenko A, Pisarev V. HEMOPERFUSION USING THE LPS-SELECTIVE MESOPOROUS POLYMERIC ADSORBENT IN SEPTIC SHOCK: A MULTICENTER RANDOMIZED CLINICAL TRIAL. Shock 2023; 59:846-854. [PMID: 37018802 PMCID: PMC10227945 DOI: 10.1097/shk.0000000000002121] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
ABSTRACT Extracorporeal hemoperfusion (EHP) may improve the course and outcomes of patients with septic shock by targeting cytokines or bacterial endotoxins (lipopolysaccharide [LPS]). Here, we present the results of a multicenter randomized controlled trial ( clinicaltrials.gov/ct2/show/NCT04827407 ) to assess the efficiency and safety of Efferon LPS hemoperfusion cartridges engineered for multimodal targeting LPS, host-derived cytokine, and damage-associated molecule pattern molecules. Patients with intra-abdominal sepsis (IAS) and septic shock (Sepsis-3) were subjected to EHP procedures (n = 38). Control patients with IAS and septic shock (n = 20) were treated using conventional protocols without EHP. The primary end point was resolution of septic shock. Secondary end points included MAP, vasopressor drug dose, partial pressure of arterial oxygen/fraction of inspired oxygen ratio, Sequential Organ Failure Assessment score, length of stay in the intensive care unit, and satisfaction with device use by a 5-point Likert scale. Clinical laboratory tests for a blood cells count, lactate and creatinine concentration, nephelometry test for C-reactive protein, immunochemiluminescent test for procalcitonin, and immunoenzyme analysis for IL-6 concentration were used to monitor the EHP effect versus the control group. Data were analyzed followed the intention-to-treat approach. Wilcoxon STATA 16.0 (StataCorp, College Station, TX) and Excel 2019 with XLStat 2019 add-in (Addinsoft, Paris, France) were used for statistical analysis of the results. The Fine and Gray method of competing risks was used to analyze the primary end point and other data representing the time to event. EHP resulted in a significant and rapid increase in MAP and partial pressure arterial oxygen/fraction of inspired oxygen ratio, progressive decline in norepinephrine doses, and multiorgan deficiency, as evaluated by Sequential Organ Failure Assessment scores. Importantly, EHP led to significantly rapid cumulative mechanical ventilation weaning compared with the control group (subdistribution hazard ratio, 2.5; P = 0.037). Early 3-day mortality was significantly reduced in the Efferon LPS versus control group; however, no significant improvements in survival in 14 and 28 days were revealed. Laboratory tests showed rapidly decreased levels of LPS, procalcitonin, C-reactive protein, IL-6, creatinine, leukocytes, and neutrophils only in the Efferon LPS group. Results demonstrate that EHP with Efferon LPS is a safe procedure to abrogate septic shock and normalize clinical and pathogenically relevant biomarkers in patients with IAS.
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Affiliation(s)
- Sergei Rey
- N.V. Sklifosovsky Research Institute for Emergency Medicine
| | | | - Alexander Popov
- A.N. Nesmeyanov Institute of Organoelement Compounds, Russian Academy of Sciences
| | - Olga Nikitina
- N.V. Sklifosovsky Research Institute for Emergency Medicine
| | | | - Marat Magomedov
- N.I. Pirogov City Clinical Hospital N1
- Pirogov Russian National Research Medical University
| | - Timur Kim
- N.I. Pirogov City Clinical Hospital N1
| | | | | | | | | | | | | | | | - Anastasia Chumachenko
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Vladimir Pisarev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
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Gao H, Wang B, Yao H, Zhang W, Teng H. Application of blood purification technology in severe fever with thrombocytopenia syndrome. Biotechnol Genet Eng Rev 2023:1-10. [PMID: 37249204 DOI: 10.1080/02648725.2023.2219940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The purpose of this paper is to summarize the blood purification technology applied in patients with severe fever with thrombocytopenia syndrome (SFTS) in the clinical treatment effect. METHODS The medical records of 96 patients with severe SFTS admitted to Weihai Municipal Hospital affiliated to Shandong University from May 2014 to November 2019 were retrospectively analyzed, and they were divided into survival group and death group. The differences in basic data test indexes and treatment method selection during intensive care unit (ICU) admission between the two groups were significantly analyzed, and the indexes with statistically significant differences were included in the multivariate logistic regression analysis related to prognosis. RESULTS There were no statistically significant differences in age, sex composition, white blood cell count, platelet count, creatine kinase (CK), activated partial thromboplastin time (APTT), serum creatinine and hemofiltration renal replacement therapy between the survival group and the death group. There were statistically significant differences between the two groups in viral load bilirubin and the treatment methods of plasma exchange (PE) or hemoperfusion (HP). Plasma exchange group (78 cases), hemofiltration group (12 cases), hemoperfusion group (6 cases), plasma exchange and hemoperfusion and other blood purification treatment of the prognosis were statistically different. CONCLUSIONS Compared with the three blood purification methods, plasmapheresis has a significant effect on virus removal, improvement of coagulation function and survival rate in patients with severe SFTS. Hemofiltration plays a role in removing inflammatory mediators, replacing renal function, maintaining electrolytes and acid-base balance, but not in removing viruses.
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Affiliation(s)
- Hongxia Gao
- Department of Critical Care Medicine, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai city, Shandong Province, China
| | - Baoyin Wang
- Emergency Department, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai city, Shandong Province, China
| | - Hui Yao
- Department of Critical Care Medicine, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai city, Shandong Province, China
| | - Wenjie Zhang
- Department of Critical Care Medicine, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai city, Shandong Province, China
| | - HaiFeng Teng
- Department of Critical Care Medicine, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai city, Shandong Province, China
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Saldaña-Gastulo JJC, Llamas-Barbarán MDR, Coronel-Chucos LG, Hurtado-Roca Y. Cytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis. Crit Care Sci 2023; 35:217-225. [PMID: 37712812 PMCID: PMC10406402 DOI: 10.5935/2965-2774.20230289-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/18/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To analyze the effect of CytoSorb® on mortality, interleukin levels, vasopressor use and adverse events in patients with sepsis. METHODS We searched MEDLINE®, Embase and the Cochrane Library for randomized controlled trials and cohort studies that reported the use of CytoSorb® among septic patients. The primary outcome was mortality, and secondary outcomes included the use of vasopressors, levels of inflammatory markers, predicted versus observed mortality, length of stay in the intensive care unit, and adverse events. RESULTS We included 6 studies enrolling 413 patients, and assessment for risk of bias indicated variations in study quality from high to moderate. The overall mortality rate was 45%, and no significant effect on mortality was found at 28 - 30 days (RR 0.98 [0.12 - 8.25] for the randomized clinical trial and RR 0.74 [0.49 - 1.13] for cohort studies). We did not perform a metanalysis for other outcomes due to the small number of studies found or the lack of data. CONCLUSION Our study found very low certainty evidence, due to imprecision, risk of bias, and heterogeneity, thereby showing no benefit of CytoSorb® use in terms of mortality at 28 - 30 days. We cannot recommend the use of CytoSorb® in septic or septic shock patients outside clinical trials. Further high-quality randomized trials with a common intervention arm are needed to evaluate the influence of CytoSorb® in this population. PROSPERO REGISTER CRD42021262219.
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Hui WF, Cheung WL, Hon KL, Ku SW. The application of hemoadsorption for hyperbilirubinemia and its impact on bilirubin removal kinetics in critically ill children. Int J Artif Organs 2023; 46:241-247. [PMID: 36964647 DOI: 10.1177/03913988231163608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Extracorporeal blood purification (EBP) is increasingly applied for bilirubin removal in critical care setting. We retrospectively reviewed the clinical features of children aged 1 month to 18 years old who received EBP for hyperbilirubinemia and explored the bilirubin removal kinetics by hemoadsorption (HA) in the pediatric intensive care unit of Hong Kong Children's Hospital from 3/2019 to 7/2022. Among the 14 episodes of EBP from six patients with a median age (interquartile range [IQR]) of 9.3(5.5) years old, 57.1% of them received HA, 33.3% received single-pass albumin dialysis (SPAD), and 7.1% received combined SPAD and HA. All HA episodes employed the Cytosorb® column. The median (IQR) pre-HA peak total bilirubin level was 406 (254) μmol/L. The saturation duration per HA episode was significantly shorter than the corresponding total treatment duration (8 vs 24 h, p = 0.012), and the median total and effective HA doses were 9.8(6.8) L/kg and 300.0 (163.4) mL/kg/h respectively. The overall bilirubin removal ratio by HA was 44.6 (14.5)%. A higher HA effective dose and a higher pre-HA bilirubin level were both associated with better bilirubin removal. No major EBP-specific complication was encountered. The liver enzymes showed improvement in all children. No patients required liver transplantation. There was no EBP-related mortality, but the overall PICU mortality of the cohort was 50%. HA was a safe and effective modality for bilirubin removal among children. Future studies should investigate the impact of bilirubin removal on clinical outcomes and explore the factors responsible for better removal efficacy.
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Affiliation(s)
- Wun Fung Hui
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Wing Lum Cheung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Kam Lun Hon
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Shu Wing Ku
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
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28
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Piscitani L, Leone S, Di Biase J, Salvati L, Sirolli V, Tunno M, Bonomini M. Efficacy of hemoperfusion with Seraph-100 in series with single pass albumin dialysis in acute hepatitis B infection: A case report. Int J Artif Organs 2023; 46:81-84. [PMID: 36482663 DOI: 10.1177/03913988221143142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute and acute-on-chronic liver failure is a cause of death in patients suffering from viral hepatitis, and many cases need liver transplantation. Infection from hepatitis B virus may range from asymptomatic to severe acute and fulminant hepatitis. In this setting, treatment is mainly supportive as there is no consensus on antiviral therapy based on non-nucleoside reverse transcriptase inhibitors. Single-pass albumin dialysis is a liver-support technique for patients suffering from liver failure, that has shown effectiveness in the removal of both water-soluble and albumin-bound toxins, which accumulate due to impairment of the liver's cleansing function. We report here the case of a 62-year-old male who presented with a severe acute hepatitis B infection, liver failure, and marked hyperbilirubinemia. Treatment with single-pass albumin dialysis combined with a hemoperfusion device was successful in improving clinical, physiological, and laboratory parameters.
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Affiliation(s)
- Luca Piscitani
- Nephrology and Dialysis Unit, Department of Medicine, S. Salvatore Hospital, L'Aquila, Italy
| | - Silvia Leone
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, S. Salvatore Hospital, Italy
| | - Jessica Di Biase
- Infection Diseases Unit, Department of Medicine, SS Filippo e Nicola Hospital, Avezzano, Italy
| | - Lia Salvati
- Infection Diseases Unit, Department of Medicine, SS Filippo e Nicola Hospital, Avezzano, Italy
| | - Vittorio Sirolli
- Nephrology and Dialysis Unit, Department of Medicine, G. d'Annunzio University of Chieti-Pescara, SS. Annunziata Hospital, Chieti, Italy
| | - Marilena Tunno
- Nephrology and Dialysis Unit, Department of Medicine, S. Salvatore Hospital, L'Aquila, Italy
| | - Mario Bonomini
- Nephrology and Dialysis Unit, Department of Medicine, G. d'Annunzio University of Chieti-Pescara, SS. Annunziata Hospital, Chieti, Italy
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Yu Y, Ou L. The development of immunosorbents for the treatment of systemic lupus erythematosus via hemoperfusion. Front Med (Lausanne) 2023; 9:1035150. [PMID: 36687455 PMCID: PMC9845935 DOI: 10.3389/fmed.2022.1035150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/29/2022] [Indexed: 01/05/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease (AID) that involves multiple organ systems and is characterized by elevated levels of autoantibodies (ANA) and immune complexes. The immunoadsorption technique uses an extracorporeal clearance process to remove pathogenic toxins from patients' blood and alleviate disease symptoms. An immunosorbent is a key component of the immunoadsorption system that determines therapeutic efficacy and safety. Immunosorbents are prepared by immobilizing antibodies, antigens, or ligands with specific physicochemical affinities on a supporting matrix. Immunosorbents and pathogenic toxins bind via affinity adsorption, which involves electrostatic interactions, hydrogen bonds, hydrophobic interactions, and van der Waals forces. Immunosorbents are classified on the basis of their interaction mechanism with toxins into three categories: non-selective, semi-selective, and highly selective. This review aimed to summarize the current status of various commercial immunosorbents that are used to treat SLE. Moreover, recent developments in immunosorbents have heightened the need for a brief discussion about specific ligands and a supporting matrix.
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Affiliation(s)
- Yameng Yu
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China,Beijing Key Laboratory of Digital Stomatology, NMPA Key Laboratory for Dental Materials, Department of Dental Materials, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital, Material Technology of Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Lailiang Ou
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China,*Correspondence: Lailiang Ou ✉
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Darban M, Yarmohamadi M, Mohammadkhani MM, Jazaeri SM. Outcome and Complications of Hemoperfusion in Patients with COVID-19 in Intensive Care Unit: A Cross-Sectional Study. Cardiovasc Hematol Agents Med Chem 2023; 21:60-66. [PMID: 35570551 DOI: 10.2174/1871525720666220514164855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND & OBJECTIVE The use of the hemoperfusion method is recommended for treating cytokine storms and reducing complications in patients with COVID-19. The side effects of this treatment are not known; therefore, this study was performed to determine the final outcome and complications of hemoperfusion in patients with COVID-19 hospitalized in ICU. METHODS In this retrospective cross-sectional study, all patients with severe COVID-19 without any comorbidities or organ failure underwent hemoperfusion treatment in ICU at Kosar Hospital in Semnan, Iran, from March to November 2021 were included. The clinical data and short-term complications up to 10 days after hemoperfusion and the final outcome were extracted from medical files. RESULTS The mean age of 40 patients with severe COVID-19 undergoing hemoperfusion was 57.5±15.9 years. Most (24, 60%) patients were male. The time interval from hospitalization to hemoperfusion and the time interval between hemoperfusion and final outcome was 4.85 days and 8.30 days, respectively. Arrhythmia, bleeding, thrombocytopenia, and coagulation disorders were the most common short-term complications of hemoperfusion in patients with COVID-19, respectively. Most complications occurred on the second and third days after hemoperfusion. Mortality occurred in 20 (50 %) patients with severe COVID-19 undergoing hemoperfusion in ICU. CONCLUSION It seems that the short-term complications and deaths due to hemoperfusion are relatively high in patients with COVID-19 admitted to the ICU. Further studies are recommended.
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Affiliation(s)
- Mahboobeh Darban
- Department of Internal Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Maliheh Yarmohamadi
- Department of Internal Medicine, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Mir Mohammadkhani
- Department of Epidemiology and Biostatistics, Semnan University of Medical Sciences, Semnan, Iran
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31
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Muacevic A, Adler JR, Carvalho E, Parente AR, Cruz Nodarse A, Pádua F. Streptococcal Toxic Shock Syndrome: A Case Report. Cureus 2022; 14:e32539. [PMID: 36654635 PMCID: PMC9839978 DOI: 10.7759/cureus.32539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Streptococcal toxic shock syndrome is a serious complication of group A Streptococcus infection with a high mortality rate. Rapid detection, early intensive care support, and surgical management are paramount in treating these patients. We present a case of a 65-year-old male, with a documented medical history of hypertension, type 2 diabetes mellitus, and peripheral arterial disease. The patient was evaluated in the emergency department with a chief complaint of pain, swelling in his left leg, and fever. Physical examination showed tachycardia, hypotension, and clear inflammatory signs in the left leg. After initial clinical and laboratory evaluation, the patient was admitted with a diagnosis of cellulitis and urinary tract infection. He presented progressive worsening with multi-organ dysfunction, requiring vasopressor support, invasive mechanical ventilation, and renal replacement therapy. Streptococcus pyogenes was isolated in blood cultures, and a streptococcal toxic shock syndrome was considered. Appropriate antibiotic therapy, immunoglobulins, hemoperfusion, and corticosteroid therapy were administered, with clinical improvement. During hospitalization, there was a progressive improvement in the skin lesion. Once clinically stabilized the patient was discharged with follow-up. The case presented shows the rapid evolution of cutaneous streptococcal infection with multiorgan dysfunction. Although these types of infections have an associated high mortality rate, this patient survived. The use of immunoglobulin and hemoperfusion technique, in this case, might have contributed to this positive outcome. Therefore, we highlight the need for high suspicion of this syndrome, especially in diabetic patients presenting with skin lesions. Once the diagnosis is established, these infections require close surveillance and rapid and intensive treatment.
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Dianaty S, Khodadadi S, Alimoghaddam R, Mirzaei A. Comparison of outcomes and costs of extracorporeal blood purification therapies in critically ill COVID-19 patients. Ther Apher Dial 2022; 27:505-516. [PMID: 36324189 PMCID: PMC9878110 DOI: 10.1111/1744-9987.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/23/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Plasmapheresis and hemoperfusion are used against cytokine release syndrome in COVID-19. This study aims to compare their outcomes, costs, and side-effects. METHODS Survival, costs and side-effects were compared in intensive care unit (ICU) patients receiving plasmapheresis (n = 49), hemoperfusion (n = 20), or none (n = 107), followed until death or discharge. RESULTS Plasmapheresis survival time was higher than hemoperfusion or controls (HR = 0.764, p = 0.397 and HR = 0.483, p = 0.002, respectively), although the latter diminished after controlling for age and disease severity (p = 0.979). There was no significant difference in ICU costs for plasmapheresis and hemoperfusion (p = 0.738) while both costed more than controls (both p < 0.001). Hypocalcemia and thrombocytopenia incidence did not differ between two groups (p = 0.124 and p = 0.389, respectively) while being higher than controls in plasmapheresis (both p < 0.001) and hemoperfusion (p < 0.001 and p = 0.056, respectively). CONCLUSION Plasmapheresis and hemoperfusion do not differ significantly in patient survival, ICU costs and side-effects with a higher incidence of hypocalcemia and thrombocytopenia compared witcontrols.
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Affiliation(s)
- Soroush Dianaty
- Student Research Committee, Tehran Medical Sciences BranchIslamic Azad UniversityTehranIran,Universal Scientific Education and Research Network (USERN)TehranIran
| | - Sanaz Khodadadi
- Student Research Committee, Tehran Medical Sciences BranchIslamic Azad UniversityTehranIran
| | - Rojina Alimoghaddam
- Student Research Committee, Tehran Medical Sciences BranchIslamic Azad UniversityTehranIran
| | - Abasat Mirzaei
- Department of Health Care Management, Faculty of Health, Tehran Medical ScienceIslamic Azad UniversityTehranIran,Health Economic Policy Research Center, Tehran Medical SciencesIslamic Azad UniversityTehranIran,Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical SciencesIslamic Azad UniversityTehranIran
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Griveas I. Effectiveness of hemoperfusion (HP) in hemodialysis (HD) patients with Covid-19 infection. Transfus Apher Sci 2022; 61:103589. [PMID: 36376212 PMCID: PMC9616508 DOI: 10.1016/j.transci.2022.103589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction The aims of this study are to observe the clinical course of all patients affected by infection with SARS-CoV-2 undergoing HD focusing on the impact of HP. Methods Patients were divided into Group A: HD sessions with HP and Group B: patients without HP. We registered all the data regarding patients’ clinical course. Results 13 patients have been enrolled in group A. 9 patients were discharged from the hospital after 43 days (range: 35–56). 30 days was the mean hospitalization stay for the deceased. We did not observe any side effects with HP cartridges. 9 patients did not receive HP during their hospitalization. For those who represented as symptomatic, 8 out of 9 patients died after 6 days of hospitalization (range: 1–14), 2 of them in ICU. Conclusion HP seems to be a helpful, safe and quite efficient tool in the battle against Covid-19 in HD patients.
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Affiliation(s)
- Ioannis Griveas
- Nephrology Department, Army Share Fund Hospital of Athens, 417 NIMTS, Greece.
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Griveas I, Pratilas E. Soluble urokinase plasminogen activator receptor and its complicated role in hemodialysis (HD) patients with Covid-19 infection. Transfus Apher Sci 2022:103590. [PMID: 36376211 PMCID: PMC9616477 DOI: 10.1016/j.transci.2022.103590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKROUND Soluble urokinase plasminogen receptor (suPAR) is a protein in the blood that has been described to reflect the severity status of systemic inflammation. AIMS AND OBJECTIVE We investigated the association between admission suPAR levels and severity and outcome of HD patients with Covid-19 infection. MATERIALS AND METHODS In an observational study of adult HD patients hospitalized for Covid-19, we measured suPAR levels in plasma samples. The time table for those measurements were as follows: at the beginning of admission, after a hemoperfusion (HP) session for those patients that received them, and just before discharge. RESULTS Of the 17 patients (7 were male), 13 patients received HP (mean age: 74 years old). The median suPAR level was 12.94 ng/ml. For those who undertook HP in HD unit the median suPAR level before the session was 12.95 ng/mil and 6.2 ng/ml at the end of each session (p < 0.05). 3 patients had a suPAR level below 7 ng/ml. 2 of them survived without developing pleural effusions. 7 patients were discharged from the hospital with median suPAR level 12.08 ng/ml which did not differ significantly from the median suPAR level of the deceased ones (13.68 ng/ml). CONCLUSION Admission levels of suPAR in HD patients hospitalized for Covid-19 do not seem to be predictive for their clinical course in general. Chronic Kidney Disease and its relation to suPAR independently of patients' inflammation status may be the key component for our notice. Despite that, in patients where low levels of suPAR combined with absence of pleural effusions the prognosis was excellent.
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Affiliation(s)
- Ioannis Griveas
- Nephrology Department, Army Share Fund Hospital of Athens, 417 NIMTS, Greece.
| | - Evaggelos Pratilas
- Nephrology Department, Army Share Fund Hospital of Athens, 417 NIMTS, Greece
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Liu Y, Wang ZK, Liu CZ, Liu YY, Li Q, Wang H, Cui F, Zhang DW, Li ZT. Supramolecular Organic Frameworks as Adsorbents for Efficient Removal of Excess Bilirubin in Hemoperfusion. ACS Appl Mater Interfaces 2022; 14:47397-47408. [PMID: 36223402 DOI: 10.1021/acsami.2c11458] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Excess bilirubin accumulates in the bodies of patients suffering from acute liver failure (ALF) to cause much irreversible damage and bring about serious clinical symptoms such as kernicterus, hepatic coma, or even death. Hemoperfusion is a widely used method for removing bilirubin from the blood, but clinically used adsorbents have unsatisfactory adsorption capacity and kinetics. In this study, we prepared four supramolecular organic framework microcrystals SOF-1-4 via slow evaporation of their aqueous solutions under infrared light. SOF-1-4 possess good regularity and excellent stability. We demonstrate that all the four SOFs could serve as adsorbents for bilirubin with fast adsorption kinetics within 20 min and ultrahigh adsorption capacity of 609.1 mg g-1, driven by electrostatic interaction and hydrophobicity. The superior adsorption performance of the SOFs outperformed most of the reported bilirubin adsorbents. Remarkably, SOF-3 could remove about 90% of bilirubin in the presence of 40 g L-1 BSA with a minimal loss of albumin and was thus further processed to a bead-shaped composite with a diameter of 2 mm with poly(ether sulfone) (PES). This PES-loaded SOF could efficiently adsorb bilirubin to the normal level from human plasma with an adsorption equilibrium concentration of 7.8 mg L-1 in 6 h through a dynamic hemoperfusion process. This work provides a new vitality for the development of novel bilirubin adsorbents for hemoperfusion therapy.
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Affiliation(s)
- Yamin Liu
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, Fudan University, Shanghai200438, China
| | - Ze-Kun Wang
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, Fudan University, Shanghai200438, China
| | - Chuan-Zhi Liu
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, Fudan University, Shanghai200438, China
| | - Yue-Yang Liu
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, Fudan University, Shanghai200438, China
| | - Qian Li
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, Fudan University, Shanghai200438, China
| | - Hui Wang
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, Fudan University, Shanghai200438, China
| | - Fengchao Cui
- Department of Chemistry, Northeast Normal University, Changchun130024, China
| | - Dan-Wei Zhang
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, Fudan University, Shanghai200438, China
| | - Zhan-Ting Li
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, Fudan University, Shanghai200438, China
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Ramezani M, Mostafazadeh B, Rahimi M, Evini PET, Shadnia S. Colchicine poisoning treated with hemoperfusion and hemodialysis: A case report. Clin Case Rep 2022; 10:e6419. [PMID: 36245450 PMCID: PMC9540575 DOI: 10.1002/ccr3.6419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/03/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
This case report described an improved case of colchicine poisoning using hemoperfusion and hemodialysis. The purpose of this study is to show the effectiveness of hemodialysis and hemoperfusion in colchicine toxicity when the patient does not respond to other treatments or other methods cannot be applied due to the symptoms caused by poisoning.
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Affiliation(s)
- Maral Ramezani
- Department of Pharmacology, School of MedicineArak University of Medical SciencesArakIran,Traditional and Complementary Medicine Research CenterArak University of Medical SciencesArakIran
| | - Babak Mostafazadeh
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Mitra Rahimi
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Peyman Erfan Talab Evini
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Shahin Shadnia
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
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Niazi NS, Nassar TI, Stewart IJ, Honore PM, Sharma K, Chung KK. A Review of Extracorporeal Blood Purification Techniques for the Treatment of Critically Ill Coronavirus Disease 2019 Patients. ASAIO J 2022; 68:1219-27. [PMID: 35417433 DOI: 10.1097/MAT.0000000000001761] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In late 2019, a novel betacoronavirus, later termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was discovered in patients with an unknown respiratory illness in Wuhan, China. SARS-CoV-2 and the disease caused by the novel coronavirus, coronavirus disease 2019 (COVID-19), spread rapidly and resulted in the World Health Organization declaring a pandemic in March 2020. In a minority of patients infected with SARS-CoV-2, severe illness develops characterized by a dysregulated immune response, acute respiratory distress syndrome, and multisystem organ failure. Despite the development of antiviral and multiple immunomodulatory therapies, outcomes of severe illness remain poor. In response, the Food and Drug Administration in the United States authorized the emergency use of several extracorporeal blood purification (EBP) devices for critically ill patients with COVID-19. Extracorporeal blood purification devices target various aspects of the host response to infection to reduce immune dysregulation. This review highlights the underlying technology, currently available literature on use in critically ill COVID-19 patients, and future studies involving four EBP platforms: 1) oXiris filter, 2) CytoSorb filter, 3) Seraph 100 Microbind blood affinity filter, and 4) the Spectra Optia Apheresis System with the Depuro D2000 Adsorption Cartridge.
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De Rosa S, Zanella M, Samoni S, Ronco C. Endotoxin removal therapy with Polymyxin B immobilized fiber column as a COVID-19-bedside strategy protocol for endotoxic shock. Front Nephrol 2022; 2:847305. [PMID: 37675016 PMCID: PMC10479594 DOI: 10.3389/fneph.2022.847305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 07/18/2022] [Indexed: 09/08/2023]
Abstract
Endotoxin -induced sepsis is a leading cause of ICU mortality. From 1994 to the present, PMX-HP has been available as an adjuvant therapy for endotoxin removal and immunomodulation. The efficacy and usefulness of this therapy have been demonstrated for more than a quarter of a century and are partially supported by clinical studies. However, it appears that selected subgroups of patients with endotoxic shock and with appropriate timing could benefit. Endotoxemia may be involved in the pathophysiology of COVID-19, based on enterocyte dysfunction and malabsorptive syndrome. Due to the characteristics of the microbiota, Gram-negative bacteria or their fragments (i.e., endotoxin) may translocate into the systemic circulation leading to inflammatory activation, immune dysfunction, and sepsis. In addition, patients with severe forms of COVID-19 are at risk of superimposed infections. Endotoxemia can arise due to the translocation of Gram-negative bacteria or their fragments from the gut barrier. According to the most updated evidence available from large randomized trials, septic shock patients with MODS > 9 and EA levels ranging from 0.6 to 0.9 are those who may benefit the most from PMX-HP treatment in terms of improvement of survival. As shown in a previous publication, we believe that similarly to the source control, microbiological cultures, and antibiotics administration, EA evaluation at regular intervals, and the targeted use of PMX-HP could be lifesaving and adequate within the golden hour for the diagnosis and treatment of endotoxic shock. In our center, we applied a diagnostic-clinical flowchart also for endotoxic shock related to COVID-19.
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Affiliation(s)
- Silvia De Rosa
- Department of Anesthesiology and Intensive Care, San Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Monica Zanella
- International Renal Research Institute of Vicenza, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Sara Samoni
- International Renal Research Institute of Vicenza, Vicenza, Italy
- Department of Nephrology and Dialysis, ASST Lariana, S. Anna Hospital, Como, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
- Department of Medicine, University of Padova, Padova, Italy
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Heymann M, Schorer R, Putzu A. Mortality and adverse events of hemoadsorption with CytoSorb® in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Acta Anaesthesiol Scand 2022; 66:1037-1050. [PMID: 35788557 PMCID: PMC9541789 DOI: 10.1111/aas.14115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/08/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
Background The effects and safety of extracorporeal hemoadsorption with CytoSorb® in critically ill patients with inflammatory conditions are controversial. Methods We performed a systematic review with meta‐analysis and trial sequential analysis (TSA) of randomized‐controlled trials to assess the mortality and safety of CytoSorb® therapy in critically ill patients with inflammatory conditions. Electronic databases were searched up to April 2022. The primary outcome was mortality at longest follow‐up and secondary outcomes included various adverse event (AE) outcomes. Conflict of interest and funding of each trial were assessed. We calculated relative risk (RR) and 95% confidence interval (CI). Results Fourteen published (n = 764) and 4 unpublished (n = 111) trials were included. Eight trials were performed in medical ICU patients and 10 in complex cardiac surgery. Ten trials had significant industrial funding or an author conflict of interest. Hemoadsorption with CytoSorb® was associated with higher mortality at latest follow‐up (16 trials, n = 807, 120 of 402 [29.85%] patients in the CytoSorb® group vs. 98 of 405 [24.20%] patients in the control group, RR = 1.24 [95% CI, 1.04–1.49], p = .02, [TSA‐adjusted CI, 0.92–1.68]) and at 30‐days or in‐hospital (11 trials, n = 727; RR = 1.41 [95% CI, 1.06–1.88], p = .02, [TSA‐adjusted CI, 0.44–4.62]). Only one trial reported the definition of adverse event, while detailed results were reported in 3 trials; the risk of adverse events was not higher with CytoSorb®. Certainty of evidence ranged from low to very low. Conclusion Low certainty of evidence showed that the use of CytoSorb® might increase mortality in critically ill patients with inflammatory conditions. Adverse events were frequent but underreported and not systematically evaluated. Industrial funding and conflict of interest were common. Considerable uncertainty about the findings does not allow firm conclusions and suggests a need for high‐quality randomized trials to clarify mortality and adverse events related to CytoSorb®. Editorial Comment Hemoadsorption with CytoSorb® have been used in critically ill patients despite lack of high quality data from RCTs suggesting any patient‐important benefits. The findings from this systematic review and meta‐analysis suggests an increased risk of adverse events including mortality. With no apparent benefits and at the same time risk of harm, use of hemoadsorption with CytoSorb® in daily clinical practice cannot be recommended at this time.
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Affiliation(s)
- Marc Heymann
- Division of Anesthesiology, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Raoul Schorer
- Division of Anesthesiology, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandro Putzu
- Division of Anesthesiology, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
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Wardoyo EY, Sari AP, Djojo AY, Sarwono J, Mokoagow MI, Darnindro N, Nasarudin J, Epriliawati M, Manurung A, Iskandar M, Wibisana KA, Widyastuti AAA, Mardiyah R. Hemoperfusion as an Adjuvant Therapy in Maintenance Hemodialysis Patients with Severe COVID-19: A Single Centre Experience. Acta Med Indones 2022; 54:444-450. [PMID: 36156468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Mortality rate among maintenance hemodialysis (HD) patients with COVID-19 is alarmingly high. In Fatmawati General Hospital, most of HD patients with COVID-19 presented with acute respiratory distress syndrome (ARDS). Hemoperfusion (HP) is a blood purification therapy used to remove cytokines and inflammatory mediators to prevent ARDS worsening and organ failure. We report 6 cases of COVID-19 in maintenance HD patients. HP and HD were performed in two consecutive days when patient developed early ARDS as indicated by inflammatory markers elevation. HP and HD were conducted by using resin-containing cartridge and high-flux dialyzer, respectively, for 4 hours. Improvements in CRP levels, PaO2/FiO2 ratios, and chest X-rays were observed after 2 sessions of HP in most of our patients. Based on our clinical experience, the timing of HP delivery is critical and should be undertaken in the early phase of ARDS, but larger studies are still needed.
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Affiliation(s)
- Elizabeth Yasmine Wardoyo
- Division of Renal Hypertension, Department of Internal Medicine, Fatmawati Hospital, Jakarta, Indonesia.
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Li X, Liu J, Cui S, Jian T, Ma S, Shi L, Lin Y, Zhang J, Zheng Y, Zhang Y, Jian X, Luan X, Kan B. Development and validation of a prediction model of deep venous thrombosis for patients with acute poisoning following hemoperfusion: a retrospective analysis. J Int Med Res 2022; 50:3000605221089779. [PMID: 35437041 PMCID: PMC9021492 DOI: 10.1177/03000605221089779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To develop and confirm an individualized predictive model to ascertain the probability of deep venous thrombosis in patients with acute poisoning after undergoing hemoperfusion. Methods Three hundred eleven patients with acute poisoning who were admitted to a hospital in China between October 2017 and February 2019 were included in the development group. Eighty patients with acute poisoning who were admitted between February and May 2019 were included in the validation group. The independent risk factors for deep venous thrombosis were examined. An individualized predictive model was developed using regression coefficients. Results The number of catheter indwelling days, having a catheter while being transported, elevated serum homocysteine concentrations, and dyslipidemia were independent risk factors for deep venous thrombosis following hemoperfusion in patients with acute poisoning. The areas under the receiver operating characteristic curve of the development and validation groups were 0.713 and 0.702, respectively, which suggested that the prediction model had good discrimination capacity. The calibration belts of the two groups were ideal. Conclusions Our prediction model has a moderate predictive effect for the occurrence of deep venous thrombosis in patients with acute poisoning. In clinical practice, this model could be combined with a common thrombosis risk assessment model.
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Affiliation(s)
- Xiuqin Li
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China
| | - Jing Liu
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China
| | - Siqi Cui
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Tianzi Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Department of Digestive Internal Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Shuang Ma
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China.,Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Longke Shi
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Ying Lin
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China
| | - Juan Zhang
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China.,Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Yingying Zheng
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China.,Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Yanxia Zhang
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China.,Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Xiaorong Luan
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China.,Department of Nursing, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Baotian Kan
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China
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Onogi C, Osada A, Imai K, Mimura T, Saka Y, Urahama Y, Oishi H, Naruse T. Two cases of ceftriaxone-induced encephalopathy treated by hemoperfusion in hemodialysis patients. Hemodial Int 2022; 26:E27-E30. [PMID: 35441472 PMCID: PMC9545014 DOI: 10.1111/hdi.13018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/19/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022]
Abstract
Ceftriaxone is a third‐generation cephalosporin commonly used to treat infection. However, encephalopathy is an emerging adverse effect of ceftriaxone infusion. These patients present with various symptoms, including those of neurotoxicity, that typically resolve 1 week after discontinuation of ceftriaxone. We experienced two cases of ceftriaxone‐induced encephalopathy that were successfully treated by rapid removal of ceftriaxone by hemoperfusion.
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Affiliation(s)
- Chikao Onogi
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Akinori Osada
- Department of Nephrology, Komaki City Hospital, Komaki, Japan
| | - Kentaro Imai
- Department of Nephrology, Komaki City Hospital, Komaki, Japan
| | - Tetsushi Mimura
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Yosuke Saka
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | | | - Hideto Oishi
- Department of Nephrology, Komaki City Hospital, Komaki, Japan
| | - Tomohiko Naruse
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
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Chitty SA, Mobbs S, Rifkin BS, Stogner SW, Lewis MS, Betancourt J, DellaVolpe J, Abouzahr F, Wilhelm AM, Szerlip HM, Parikh A, Gaeta RM, Rivera I, Park C, Levi B, Anesi GL, Alcover KC, Arnold TB, Howard JT, Sharma K, Pratt KP, Stewart IJ, Chung KK. A Multicenter Evaluation of the Seraph 100 Microbind Affinity Blood Filter for the Treatment of Severe COVID-19. Crit Care Explor 2022; 4:e0662. [PMID: 35506015 DOI: 10.1097/CCE.0000000000000662] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Seraph100 Microbind Affinity Blood Filter (Seraph 100) (ExThera Medical, Martinez, CA) is an extracorporeal therapy that can remove pathogens from blood, including severe acute respiratory syndrome coronavirus 2. The aim of this study was to evaluate safety and efficacy of Seraph 100 treatment for COVID-19. DESIGN Retrospective cohort study. SETTING Nine participating ICUs. PATIENTS COVID-19 patients treated with Seraph 100 (n = 53) and control patients matched by study site (n = 53). INTERVENTION Treatment with Seraph 100. MEASUREMENTS AND MAIN RESULTS At baseline, there were no differences between the groups in terms of sex, race/ethnicity, body mass index, and need for mechanical ventilation. However, patients in the Seraph 100 group were younger (median age, 54 yr; interquartile range [IQR], 41-65) compared with controls (median age, 64 yr; IQR, 56-69; p = 0.009). Charlson comorbidity index scores were lower in the Seraph 100 group (2; IQR, 0-3) compared with the control group (3; IQR, 2-4; p = 0.006). Acute Physiology and Chronic Health Evaluation II scores were also lower in Seraph 100 subjects (12; IQR, 9-17) compared with controls (16; IQR, 12-21; p = 0.011). The Seraph 100 group had higher vasopressor-free days with an incidence rate ratio of 1.30 on univariate analysis. This difference was not significant after adjustment. Seraph 100-treated subjects were less likely to die compared with controls (32.1% vs 64.2%; p = 0.001), a difference that remained significant after adjustment. However, no difference in mortality was observed in a post hoc analysis utilizing an external control group. In the full cohort of 86 treated patients, there were 177 total treatments, in which only three serious adverse events were recorded. CONCLUSIONS Although this study did not demonstrate consistently significant clinical benefit across all endpoints and comparisons, the findings suggest that broad spectrum, pathogen agnostic, blood purification can be safely deployed to meet new pathogen threats while awaiting targeted therapies and vaccines.
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Liu Y, Shu H, Long Y, Nie X, Tang H, Tu L, Zhang H, Qiu G, He D, Huang Q, Zhang Q, Qing S, Xu D, Xia H. Development and internal validation of a Wasp Sting Severity Score to assess severity and indicate blood purification in persons with Asian wasp stings. Clin Kidney J 2022; 15:320-327. [PMID: 35145646 PMCID: PMC8825213 DOI: 10.1093/ckj/sfab201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Indexed: 02/05/2023] Open
Abstract
Background In recent years, the incidence of wasp sting has increased annually in China. Organ damage and high mortality due to mass wasp envenomation remain major challenges. Timely and appropriate medical intervention can improve survival. However, there are currently no normalized tools for early assessment of severity. Methods The clinical data of wasp sting patients hospitalized from 2011 to 2019 were used as a training set. Logistic regression was used to explore major risk factors for the development of a severe case of wasp sting (SC). The Wasp Sting Severity Score (WSS) was determined considering these risk factors to identify SCs and was tested in a validation dataset that was prospectively collected in 2020. Results The data of 1131 wasp sting patients from 2011 to 2019 were included in the training set. Logistic regression analysis showed that tea-colored urine, number of stings, and lactate dehydrogenase and total bilirubin levels were risk factors for developing an SC. The WSS was developed considering these four risk factors, and the total possible WSS was 20 points. The WSS was tested using the validation dataset, comprising the data of 153 patients, in 2020, and we found that a WSS ≥3 points was an important indication for blood purification, with a sensitivity of 71.9%, specificity of 92.6% and an area under the curve of 0.918 (95% confidence interval 0.873–0.962). Among patients with more than 30 stings, mortality in those who underwent plasma exchange (PE) within 24 h after admission was significantly lower than that in those who did not receive PE treatment (14.3% versus 46.9%, P = 0.003). However, continuous venovenous hemofiltration (CVVH) (P = 0.317) and hemoperfusion (HP) (P = 0.869) did not significantly reduce mortality. Conclusions Patients with WSS scores ≥3 should be considered for blood purification as early as possible in addition to routine treatment. In addition, PE is better than CVVH and HP at reducing mortality in patients suffering from severe wasp stings.
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Affiliation(s)
- Yong Liu
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Hongmei Shu
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Youlin Long
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaoqin Nie
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Hongfu Tang
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Lang Tu
- Department of Critical Care Medicine, Shehong People's Hospital, Sichuan Province, China
| | - Hao Zhang
- Department of Critical Care Medicine, Shehong People's Hospital, Sichuan Province, China
| | - Gang Qiu
- Department of Critical Care Medicine, Pengxi County People's Hospital, Sichuan Province, China
| | - Daihua He
- Department of Critical Care Medicine, Pengxi County People's Hospital, Sichuan Province, China
| | - Qiang Huang
- Department of Critical Care Medicine, Daying County People's Hospital, Sichuan Province, China
| | - Qi Zhang
- Department of Critical Care Medicine, Daying County People's Hospital, Sichuan Province, China
| | - Shuang Qing
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Donglin Xu
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Hongtao Xia
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
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Tiranathanagul K, Khemnark N, Takkavatakarn K, Limjariyakul M, Mahatanan N, Chariyavilaskul P, Wittayalertpanya S, Susantitaphong P, Eiam-Ong S. Comparative efficacy between hemodialysis using super high-flux dialyzer with hemoperfusion and high-volume postdilution online hemodiafiltration in removing protein bound and middle molecule uremic toxins: A cross-over randomized controlled trial. Artif Organs 2022; 46:775-785. [PMID: 35028951 DOI: 10.1111/aor.14161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hemodialysis (HD) using super high-flux dialyzer (HD + SHF) comparably removed uremic toxins to high-volume postdilution online hemodiafiltration (olHDF). Integration of hemoperfusion (HP) to HD + SHF (HD + SHF + HP) might provide superior uremic toxin removing capability to high-volume postdilution olHDF. METHOD The present study was conducted in thrice-a-week HD patients to compare the efficacy in removing indoxyl sulfate (IS), beta-2 microglobulin (β2 M), and urea between high-volume postdilution ol-HDF and HD + SHF + HP, comprising HD + SHF as the main treatment plus HD + SHF + HP 1/week in the first 4 weeks and 1/2 weeks in the second 4 weeks. RESULTS Ten prevalent HD patients with blood flow rate (BFR) above 400 ml/min were randomized into two sequences of 8-week treatment periods of HD + SHF + HP and later high-volume postdilution olHDF or vice versa. When compared with high-volume postdilution olHDF (convective volume of 26.02 ± 1.8 L/session), HD + SHF + HP provided comparable values of percentage reduction ratio of IS (52.0 ± 11.7 vs. 56.3 ± 7.5%, p = 0.14) and β2 M (83.7 ± 4.9 vs. 84.0 ± 4.3%, p = 0.37) and slightly lower urea reduction ratio. Despite greater dialysate albumin loss (p = 0.008), there was no significant change in serum albumin level in HD + SHF + HP group. CONCLUSIONS HD + SHF + HP could not provide superior efficacy in removing uremic toxins to high-volume postdilution olHDF. The use of low BFR of 200 ml/min during the first 2 h of HD + SHF + HP session, according to the instruction of manufacturer, might impair the efficacy of the HD + SHF part in removing uremic toxins.
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Affiliation(s)
- Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Chulalongkorn University, Bangkok, Thailand
| | - Nutchaya Khemnark
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Chulalongkorn University, Bangkok, Thailand
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Chulalongkorn University, Bangkok, Thailand
| | - Maneerut Limjariyakul
- Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Clinical Pharmacokinetics and Pharmacogenomics Research Unit, Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nunta Mahatanan
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Chulalongkorn University, Bangkok, Thailand.,Department of Nursing, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pajaree Chariyavilaskul
- Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Clinical Pharmacokinetics and Pharmacogenomics Research Unit, Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Chulalongkorn University, Bangkok, Thailand.,Research Unit for Metabolic Bone Disease in CKD patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Chulalongkorn University, Bangkok, Thailand
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Abstract
We report two suicidal cases of acute methyl ethyl ketone peroxide (MEKP) poisoning. A woman in her late 60s suffered from oral mucosal erosion, functional impairment of the heart, liver and other organs, pulmonary inflammation, elevated inflammatory markers, pleural effusion, hypoproteinemia and metabolic acidosis after oral administration of approximately 50 mL of MEKP. After admission, the patient was administered hemoperfusion four times, 8 mg of betamethasone for 6 days and symptomatic support. Hemoperfusion had an obvious effect on the treatment of oral MEKP poisoning. After discharge, the patient developed progressive dysphagia and secondary esophageal stenosis. Supplementary feeding was administered with a gastrostomy tube after the patient was completely unable to eat. A man in his mid-40s developed oropharyngeal mucosal erosion, bronchitis and esophageal wall thickening after oral administration of 40 ml MEKP. After receiving total gastrointestinal dispersal, 80 mg of methylprednisolone was administered for 7 days, and symptomatic supportive treatment was provided. Slight dysphagia was observed after discharge, and there was no major effect on the quality of life. Patients with acute oral MEKP poisoning should be followed up regularly to observe its long-term effects on digestive tract corrosion and stenosis.
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Affiliation(s)
- Cece Sun
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Tianzi Jian
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yaqian Li
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Siqi Cui
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,School of Public Health, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, China
| | - Longke Shi
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,School of Public Health, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, China
| | - Guangcai Yu
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Baotian Kan
- School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Geriatric Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Song T, Hayanga J, Durham L, Garrison L, McCarthy P, Barksdale A, Smith D, Bartlett R, Jaros M, Nelson P, Molnar Z, Deliargyris E, Moazami N. CytoSorb Therapy in COVID-19 (CTC) Patients Requiring Extracorporeal Membrane Oxygenation: A Multicenter, Retrospective Registry. Front Med (Lausanne) 2022; 8:773461. [PMID: 34988092 PMCID: PMC8720923 DOI: 10.3389/fmed.2021.773461] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: CytoSorb extracorporeal blood purification therapy received FDA Emergency Use Authorization (EUA) to suppress hyperinflammation in critically ill COVID-19 patients. The multicenter CTC Registry was established to systematically collect patient-level data, outcomes, and utilization patterns of CytoSorb under the EUA. Methods: Patient-level data was entered retrospectively at participating centers. The primary outcome of the registry was ICU mortality. Patient disposition of death, continuing ICU care, or ICU discharge was analyzed up to Day 90 after start of CytoSorb therapy. Demographics, comorbidities, COVID-19 medications, inflammatory biomarkers, and details on CytoSorb use were compared between survivors and non-survivors in the veno-venous extracorporeal membrane oxygenation (ECMO) cohort. Results: Between April 2020 and April 2021, 52 patients received veno-venous ECMO plus CytoSorb therapy at 5 U.S. centers. ICU mortality was 17.3% (9/52) on day 30, 26.9% (14/52) on day 90, and 30.8% (16/52) at final follow-up of 153 days. Survivors had a trend toward lower baseline D-Dimer levels (2.3 ± 2.5 vs. 19.8 ± 32.2 μg/mL, p = 0.056) compared to non-survivors. A logistic regression analysis suggested a borderline association between baseline D-Dimer levels and mortality with a 32% increase in the risk of death per 1 μg/mL increase (p = 0.055). CytoSorb was well-tolerated without any device-related adverse events reported. Conclusions: CytoSorb therapy for critically ill COVID-19 patients on ECMO was associated with high survival rates suggesting potential therapeutic benefit. Elevated baseline D-Dimer levels may suggest increased risk of mortality. Prospective controlled studies are warranted to substantiate these results. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT0439192, identifier: NCT04391920.
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Affiliation(s)
- Tae Song
- University of Chicago Medicine, Chicago, IL, United States
| | - Jeremiah Hayanga
- West Virginia University School of Medicine, Morgantown, WV, United States
| | - Lucian Durham
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Paul McCarthy
- West Virginia University School of Medicine, Morgantown, WV, United States
| | - Andy Barksdale
- Franciscan Health Indianapolis, Indianapolis, IN, United States
| | - Deane Smith
- New York University Grossman School of Medicine, New York, NY, United States
| | - Robert Bartlett
- University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Mark Jaros
- Summit Analytical LLC, Denver, CO, United States
| | - Peter Nelson
- CytoSorbents Corporation, Princeton, NJ, United States
| | - Zsolt Molnar
- CytoSorbents Europe, Berlin, Germany.,Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.,Department of Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Nader Moazami
- New York University Grossman School of Medicine, New York, NY, United States
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48
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Tracy A, Lynch A, Messenger K, Vaden S, Vigani A. Use of extracorporeal therapy in a dog with heatstroke. J Vet Emerg Crit Care (San Antonio) 2021; 32:512-519. [PMID: 34904781 DOI: 10.1111/vec.13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/14/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the use of extracorporeal therapy (ECT) in the management of a dog with complications stemming from heatstroke. CASE REVIEW A 3-year-old intact male Rhodesian Ridgeback was presented for heat-related illness following strenuous exercise. Despite intensive supportive care, the dog developed progressive and refractory hyperkalemia, hypoglycemia, neurologic dysfunction, acute kidney injury (AKI), and pulmonary dysfunction. Four ECT sessions were performed in this dog, consisting of 4 intermittent hemodialysis (HD) sessions, the first 2 of which concurrently utilized hemoperfusion with a cytokine adsorption filter. Interleukin-6 (IL-6), IL-8, IL-10, and monocyte chemoattractant protein-1 were detected in samples collected during the first ECT session. Despite an initial decrease in their concentration, the concentrations of these cytokines ultimately rose over the course of the ECT session. Rapid and sustained glycemic and electrolyte control were achieved after the first ECT session, although AKI and muscle injury persisted. The dog survived to discharge and was nonazotemic 3 months following initial management. NEW OR UNIQUE INFORMATION PROVIDED Heatstroke is a common, potentially catastrophic, occurrence in dogs. To the authors' knowledge, this represents the first clinical use of ECT consisting of HD and cytokine adsorption in the management of severe heat-related illness in a dog. The use of ECT for the management of complications from severe heatstroke in dogs warrants further investigation.
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Affiliation(s)
- Alyx Tracy
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Alex Lynch
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Kristen Messenger
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Shelly Vaden
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Alessio Vigani
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Bouchard J, Yates C, Calello DP, Gosselin S, Roberts DM, Lavergne V, Hoffman RS, Ostermann M, Peng A, Ghannoum M. Extracorporeal Treatment for Gabapentin and Pregabalin Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup. Am J Kidney Dis 2021; 79:88-104. [PMID: 34799138 DOI: 10.1053/j.ajkd.2021.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/11/2021] [Indexed: 11/11/2022]
Abstract
Toxicity from gabapentin and pregabalin overdose is commonly encountered. Treatment is supportive, and the use of extracorporeal treatments (ECTRs) is controversial. The EXTRIP workgroup conducted systematic reviews of the literature and summarized findings following published methods. Thirty-three articles (30 patient reports and 3 pharmacokinetic studies) met the inclusion criteria. High gabapentinoid extracorporeal clearance (>150mL/min) and short elimination half-life (<5 hours) were reported with hemodialysis. The workgroup assessed gabapentin and pregabalin as "dialyzable" for patients with decreased kidney function (quality of the evidence grade as A and B, respectively). Limited clinical data were available (24 patients with gabapentin toxicity and 7 with pregabalin toxicity received ECTR). Severe toxicity, mortality, and sequelae were rare in cases receiving ECTR and in historical controls receiving standard care alone. No clear clinical benefit from ECTR could be identified although major knowledge gaps were acknowledged, as well as costs and harms of ECTR. The EXTRIP workgroup suggests against performing ECTR in addition to standard care rather than standard care alone (weak recommendation, very low quality of evidence) for gabapentinoid poisoning in patients with normal kidney function. If decreased kidney function and coma requiring mechanical ventilation are present, the workgroup suggests performing ECTR in addition to standard care (weak recommendation, very low quality of evidence).
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Affiliation(s)
- Josée Bouchard
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Christopher Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, SAMU 061, Balears, Spain; IdISBa Clinical Toxicology Workgroup, Palma de Mallorca, Spain
| | - Diane P Calello
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; New Jersey Poison Information and Education System, Newark, New Jersey
| | - Sophie Gosselin
- Centre Intégré de Santé et de Services Sociaux, Montérégie-Centre Emergency Department, Hôpital Charles-Lemoyne, Greenfield Park, Quebec, Canada; Department of Emergency Medicine, McGill University, Montreal, Quebec, Canada; Centre Antipoison du Québec, Quebec City, Quebec, Canada
| | - Darren M Roberts
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia; Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Valéry Lavergne
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Marlies Ostermann
- Department of Critical Care & Nephrology, King's College, London, United Kingdom; Guy's & St Thomas Hospital, London, United Kingdom
| | - Ai Peng
- Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Marc Ghannoum
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada.
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50
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Ren W, Chen Y, Wang Y, Wang C, Tian M, Gu X, Lv W. Inhibitory effect of pirfenidone on pulmonary fibrosis in patients with acute paraquat poisoning. Am J Transl Res 2021; 13:13192-13199. [PMID: 34956540 PMCID: PMC8661212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/27/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To study the efficacy of pirfenidone (PFD) on patients with pulmonary fibrosis caused by acute paraquat (PQ) poisoning. METHODS A total of 86 patients with pulmonary fibrosis caused by acute PQ poisoning admitted to our hospital were analyzed retrospectively. All of them successfully received the standard 21-day treatment based on "Taishan Consensus", and they were assigned to the PFD group or the NO-PFD group according to whether they received PFD treatment (at 200 mg/time, 3 times/day) for 6 months after discharge. The two groups were compared in effective treatment rate, mortality and incidence of adverse reactions such as liver and kidney function damage, pulmonary fibrosis-associated indexes, pulmonary function-associated indexes, and arterial blood gas indexes before and after therapy. RESULTS The PFD group showed a notably higher effective treatment rate than the NO-PFD group (P<0.05). Additionally, the PFD group showed notably lower levels of serum hyaluronic acid (HA), laminin (LN), type IV collagen (CIV), and type III procollagen (PCIII), and notably higher levels of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC than the NO-PFD group (all P<0.001), and the PFD group also showed significantly higher levels of arterial blood gas indexes including arterial partial pressure of oxygen (PaO2) and PaO2/inspired oxygen (FIO2) than the NO-PFD group (both P<0.001). Moreover, the Kaplan-Meier survival curves showed that the survival rate of the patients in PFD group was significantly higher than that in the NO-PFD group (P<0.05). CONCLUSION With a high safety, PFD can effectively improve the treatment efficacy in patients with pulmonary fibrosis caused by acute PQ poisoning. PFD can improve the pulmonary function and arterial blood gas status of patients, without causing obvious liver and kidney damage.
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Affiliation(s)
- Wenbin Ren
- Department of Emergency, The Fourth Hospital of Shijiazhuang (Shijiazhuang Obstetrics and Gynecology Hospital)Shijiazhuang 050011, Hebei Province, China
| | - Yongqiang Chen
- Department of Emergency Medicine, Lanling County People’s HospitalLinyi 277700, Shandong Province, China
| | - Yuantao Wang
- Clinical Skills Center, Shandong First Medical UniversityJi’nan 271016, Shandong Province, China
| | - Chunbao Wang
- Department of Emergency, Hengshui Eighth People’s HospitalHengshui 053500, Hebei Province, China
| | - Mimi Tian
- Department of Respiratory Medicine, Gaoqing People’s HospitalZibo 256300, Shandong Province, China
| | - Xiaoxu Gu
- Department of Emergency, The Fourth Hospital of Shijiazhuang (Shijiazhuang Obstetrics and Gynecology Hospital)Shijiazhuang 050011, Hebei Province, China
| | - Weiguo Lv
- Department of Nephrology, Laiyang Central HospitalYantai 265200, Shandong Province, China
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