Therapeutic effect of hemoperfusion for absorption of inflammatory cytokines on sepsis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HE Huiwei , XIA Wenhan , CHEN Zhi ,  YANG Chunli , YANG Xiaogang , HE Zhaohui , HUANG Cuilan , CHEN Xiaohong

Department of Critical Care Medicine, Jiangxi Provincial People's Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi 330006, P. R. China;

Corresponding author：

YANG Chunli, Email: ycl121@163.com

Keywords：

Inflammatory cytokines; hemoperfusion; sepsis; septic shock; procalcitonin; interleukin-6

DOI：

10.7507/1671-6205.202210045

Video：

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Objective To evaluate the effect of hemoperfusion for absorption of inflammatory cytokines on sepsis . Method A prospective randomized controlled study was carried out to collect 60 sepsis patients admitted to the Department of Critical Care Medicine of this hospital from June 2019 to December 2021. They were randomly divided into a study group (30 cases) and a control group (30 cases) by using the random number table method. Both groups of patients received routine treatment according to the guidelines, including fluid resuscitation, mechanical ventilation, antibiotic and vasoactive agents. For the patients with renal failure, renal replacement therapy (RRT) was used. Routine vital sign monitoring and serum procalcitonin (PCT) and interleukin-6 (IL-6) determination were recorded. The study group received two times of hemoperfusion to absorb inflammatory cytokines at 0 h and 24 h after enrollment. At 24 h and 48 h after treatment, the vital signs and related physical and chemical indexes of patients were recorded again, including norepinephrine dose, oxygenation index, PCT, IL-6 and blood lactic acid. The changes of physical and chemical indexes and the 28-day survival rate of the two groups were compared. Results There was no difference in the general situation of the two groups when they were enrolled (P>0.05). The dosage of norepinephrine [(0.77±0.48)μg·kg^–1·min^–1 vs. (0.92±0.62) μg·kg^–1·min^–1, P=0.030] and the level of blood lactic acid [(2.70±1.43)mmol/L vs. (4.05±2.60)mmol/L, P=0.001] in the study group were significantly lower than those in the control group 24 h and 48 h after treatment. The oxygenation index in the study group was higher than that of the control group 24 h after treatment (212±68)mm Hg vs. (197±42)mm Hg, P=0.042). The inflammation related indexes PCT [(17±24)ng/mL vs. (32±36)ng/mL, P=0.013] and IL-6 [299 (102, 853)pg/mL vs. 937 (247, 2230)pg/mL, P=0.026] in the study group were significantly lower than those in the control group 48 h after treatment. The dosage of noradrenaline, oxygenation index, PCT, IL-6 and blood lactate level in the study group after treatment were improved compared with those before treatment (P<0.05), while those in the control group were not significantly improved after treatment (P>0.05), and oxygenation index in the two groups had no significant difference before and after treatment (P>0.05). There was no significant difference in the 28-day survival rate between the two groups (χ²=0.211, P=0.646). Conclusion Although the hemoperfusion for absorption of inflammatory cytokine factors can not reduce the 28-day mortality of sepsis, it can significantly improve the early physical and chemical indicators of patients, and provide opportunities for follow-up treatment.

Citation： HE Huiwei, XIA Wenhan, CHEN Zhi, YANG Chunli, YANG Xiaogang, HE Zhaohui, HUANG Cuilan, CHEN Xiaohong. Therapeutic effect of hemoperfusion for absorption of inflammatory cytokines on sepsis. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(1): 13-17. doi: 10.7507/1671-6205.202210045 Copy

1.	Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest, 1992, 101(6): 1644-1655.
2.	Stevenson EK, Rubenstein AR, Radin GT, et al. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med, 2014, 42(3): 625-631.
3.	Heumann D, Glauser MP, Calandra T. Molecular basis of host-pathogen interaction in septic shock. Curr Opin Microbiol, 1998, 1(1): 49-55.
4.	Danner RL, Elin RJ, Hosseini JM, et al. Endotoxemia in human septic shock. Chest, 1991, 99(1): 169-175.
5.	Baranowsky A, Appelt J, Kleber C, et al. Procalcitonin exerts a mediator role in septic shock through the calcitonin gene-related peptide receptor. Crit Care Med, 2021, 49(1): e41-e52.
6.	Nemoto H, Nakamoto H, Okada H, et al. Newly developed immobilized polymyxin B fibers improve the survival of patients with sepsis. Blood Purif, 2001, 19(4): 361-368.
7.	Chang T, Tu YK, Lee CT, et al. Effects of polymyxin B hemoperfusion on mortality in patients with severe sepsis and septic shock: a systemic review, meta-analysis update, and disease severity subgroup meta-analysis. Crit Care Med, 2017, 45(8): e858-e864.
8.	Kuriyama A, Katsura M, Urushidani S, et al. Impact of polymyxin B hemoperfusion in the treatment of patients with sepsis and septic shock: a meta-analysis of randomized controlled trials. Ann Transl Med, 2018, 6(11): 206.
9.	Honore PM, Hoste E, Molnár Z, et al. Cytokine removal in human septic shock: where are we and where are we going?. Ann Intensive Care, 2019, 9(1): 56.
10.	中国医师协会急诊医师分会, 中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018). 中国急救医学, 2018, 28(9): 741-756.
11.	Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med, 2017, 43(3): 304-377.
12.	Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ ATS/SIS international sepsis definitions conference. Crit Care Med, 2003, 31(4): 1250-1256.
13.	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
14.	田兴国, 陈志, 贺慧为, 等. 多黏菌素B血液灌流对脓毒症和脓毒症休克患者预后影响的荟萃分析. 中国呼吸与危重监护杂志, 2020, 19(1): 16-21.
15.	Ono S, Tsujimoto H, Matsumoto A, et al. Modulation of human leukocyte antigen-DR on monocytes and CD16 on granulocytes in patients with septic shock using hemoperfusion with polymyxin B-immobilized fiber. Am J Surg, 2004, 188(2): 150-156.
16.	Aderem A, Ulevitch RJ. Toll-like receptors in the induction of the innate immune response. Nature, 2000, 406(6797): 782-787.
17.	Nishibori M, Takahashi HK, Katayama H, et al. Specific removal of monocytes from peripheral blood of septic patients by polymyxin B-immobilized filter column. Acta Med Okayama, 2009, 63(1): 65-69.
18.	Coudroy R, Payen D, Launey Y, et al. Modulation by polymyxin-B hemoperfusion of inflammatory response related to severe peritonitis. Shock, 2017, 47(1): 93-99.
19.	Becker KL, Snider R, Nylen ES. Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations. Crit Care Med, 2008, 36(3): 941-952.
20.	Remick DG. Pathophysiology of sepsis. Am J Pathol, 2007, 170(5): 1435-1444.
21.	Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med, 2021, 47(11): 1181-1247.
22.	Hawchar F, László I, Öveges N, et al. Extracorporeal cytokine adsorption in septic shock: a proof of concept randomized, controlled pilot study. J Crit Care, 2019, 49: 172-178.
23.	Rybalko A, Voronin A, Vagulin A, et al. Early use of cytokine adsorption in treatment of COVID-19 associated respiratory distress syndrome. Medicinskij alfavit, 2022, 1(17): 71-75.

1. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest, 1992, 101(6): 1644-1655.
2. Stevenson EK, Rubenstein AR, Radin GT, et al. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med, 2014, 42(3): 625-631.
3. Heumann D, Glauser MP, Calandra T. Molecular basis of host-pathogen interaction in septic shock. Curr Opin Microbiol, 1998, 1(1): 49-55.
4. Danner RL, Elin RJ, Hosseini JM, et al. Endotoxemia in human septic shock. Chest, 1991, 99(1): 169-175.
5. Baranowsky A, Appelt J, Kleber C, et al. Procalcitonin exerts a mediator role in septic shock through the calcitonin gene-related peptide receptor. Crit Care Med, 2021, 49(1): e41-e52.
6. Nemoto H, Nakamoto H, Okada H, et al. Newly developed immobilized polymyxin B fibers improve the survival of patients with sepsis. Blood Purif, 2001, 19(4): 361-368.
7. Chang T, Tu YK, Lee CT, et al. Effects of polymyxin B hemoperfusion on mortality in patients with severe sepsis and septic shock: a systemic review, meta-analysis update, and disease severity subgroup meta-analysis. Crit Care Med, 2017, 45(8): e858-e864.
8. Kuriyama A, Katsura M, Urushidani S, et al. Impact of polymyxin B hemoperfusion in the treatment of patients with sepsis and septic shock: a meta-analysis of randomized controlled trials. Ann Transl Med, 2018, 6(11): 206.
9. Honore PM, Hoste E, Molnár Z, et al. Cytokine removal in human septic shock: where are we and where are we going?. Ann Intensive Care, 2019, 9(1): 56.
10. 中国医师协会急诊医师分会, 中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018). 中国急救医学, 2018, 28(9): 741-756.
11. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med, 2017, 43(3): 304-377.
12. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ ATS/SIS international sepsis definitions conference. Crit Care Med, 2003, 31(4): 1250-1256.
13. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
14. 田兴国, 陈志, 贺慧为, 等. 多黏菌素B血液灌流对脓毒症和脓毒症休克患者预后影响的荟萃分析. 中国呼吸与危重监护杂志, 2020, 19(1): 16-21.
15. Ono S, Tsujimoto H, Matsumoto A, et al. Modulation of human leukocyte antigen-DR on monocytes and CD16 on granulocytes in patients with septic shock using hemoperfusion with polymyxin B-immobilized fiber. Am J Surg, 2004, 188(2): 150-156.
16. Aderem A, Ulevitch RJ. Toll-like receptors in the induction of the innate immune response. Nature, 2000, 406(6797): 782-787.
17. Nishibori M, Takahashi HK, Katayama H, et al. Specific removal of monocytes from peripheral blood of septic patients by polymyxin B-immobilized filter column. Acta Med Okayama, 2009, 63(1): 65-69.
18. Coudroy R, Payen D, Launey Y, et al. Modulation by polymyxin-B hemoperfusion of inflammatory response related to severe peritonitis. Shock, 2017, 47(1): 93-99.
19. Becker KL, Snider R, Nylen ES. Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations. Crit Care Med, 2008, 36(3): 941-952.
20. Remick DG. Pathophysiology of sepsis. Am J Pathol, 2007, 170(5): 1435-1444.
21. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med, 2021, 47(11): 1181-1247.
22. Hawchar F, László I, Öveges N, et al. Extracorporeal cytokine adsorption in septic shock: a proof of concept randomized, controlled pilot study. J Crit Care, 2019, 49: 172-178.
23. Rybalko A, Voronin A, Vagulin A, et al. Early use of cytokine adsorption in treatment of COVID-19 associated respiratory distress syndrome. Medicinskij alfavit, 2022, 1(17): 71-75.

Chinese Journal of Respiratory and Critical Care Medicine

Therapeutic effect of hemoperfusion for absorption of inflammatory cytokines on sepsis

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