Journal Article

Endotoxin and cytokine reducing properties of the oXiris membrane in patients with septic shock: A randomized crossover double-blind study

Bodelsson, Mikael, Hansson, Fredrik, Broman, Marcus E., Vincent, Jean-Louis

2019

Overview

Endotoxin induces an inflammatory response, with secondary release of cytokines, which can progress to shock and multiple organ failure. We explored whether continuous renal replacement therapy (CRRT) using a modified membrane (oXiris) capable of adsorption could reduce endotoxin and cytokine levels in septic patients. Sixteen patients requiring CRRT for septic shock-associated acute renal failure and who had endotoxin levels >0.03 EU/ml were prospectively randomized in a crossover double-blind design to receive CRRT with an oXiris filter or with a standard filter. Endotoxin and cytokine levels were measured at baseline and 1, 3, 8, 16 and 24 hours after the start of CRRT. Norepinephrine infusion rate and blood lactate levels were monitored. During the first filter treatment period, endotoxin levels decreased in 7 of 9 (77.8%) oXiris filter patients, but in only 1 of 6 (16.7%) standard filter patients (P = 0.02). Levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8 and interferon (IFN)γ decreased more with the oXiris filter than with the standard filter. Lactate concentration decreased with oXiris (-1.3[-2.2 to -1.1] mmol/l, P = 0.02), but not with the standard filter (+0.15[-0.95 to 0.6]). The norepinephrine infusion rate was reduced during oXiris CRRT, but not during standard filter CRRT. In the second filter treatment period, there was no significant reduction in endotoxin or cytokine levels in either group. CRRT with the oXiris filter seemed to allow effective removal of endotoxin and TNF-α, IL-6, IL-8 and IFNγ in patients with septic shock-associated acute renal failure. This may be associated with beneficial hemodynamic effects.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adsorption / Aged / Aged, 80 and over / Anestesi och intensivvård / Anesthesiology / Anesthesiology and Intensive Care / Biology and Life Sciences / Care and treatment / Clinical Medicine / Clinical trials / Continuous Renal Replacement Therapy - instrumentation / Continuous Renal Replacement Therapy - methods / Cross-Over Studies / Cytokines / Cytokines - blood / Double-Blind Method / Double-blind studies / Endotoxins / Endotoxins - blood / Failure / Female / Hemodynamics / Humans / Inflammation / Inflammatory response / Intensive care / Interferon / Interleukin 6 / Interleukin 8 / Kidneys / Klinisk medicin / Lactic acid / Male / Medical and Health Sciences / Medicin och hälsovetenskap / Medicine and Health Sciences / Membrane proteins / Membranes, Artificial / Middle Aged / Mortality / Norepinephrine / Physical Sciences / R&D / Randomization / Renal failure / Research & development / Sepsis / Septic shock / Shock, Septic - blood / Shock, Septic - therapy / Studies / Tumor necrosis factor-TNF / Tumor necrosis factor-α / γ-Interferon