Continuous Renal Replacement Therapy with oXiris® Membrane in Severe Ebstein-Barr Virus-Mediated Hemophagocytic Lymphohistiocytosis: A Case Report

Samman, Karla N.; Baalbaki, Hussein; Bouchard, Josée; Albert, Martin

doi:10.1159/000511724

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…oXiris filter is superficially modified from an AN-69 membrane (polyacrylonitrile) with an additional positively charged polyimide ethylene layer used to enhance the cytokines-adsorbing capacity by ionic bonding and grafted with heparin (Broman et al, 2019), which was first approved and marketed in Europe in 2009. The addition of the highly adsorptive preheparinized oXiris filter can enhance the ability of CRRT to effectively remove endotoxin, circulating cytokines, and inflammatory chemokines, thus reducing lactate concentration and vasopressors infusion rate, and improving haemodynamic status, systemic perfusion, multi-organ function, and clinical outcomes without related adverse events (Broman et al, 2019;Schwindenhammer et al, 2019;Turani et al, 2019;Villa et al, 2020;Samman et al, 2021). Therefore, it gained emergency approval from US Food and Drug Administration (FDA) for the clinical treatment of COVID-19 in April 2020 to counter the CRS attack triggered by SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…Study has concluded that children with HLH may require CRRT support [30,40]. Treatment with a blood puri cation CRRT membrane can signi cantly alleviate hypercytokineemia in HLH [41]. Indications for initiating CRRT include uid overload, severe metabolic acidosis, electrolyte abnormalities, and signi cant symptoms of uremia [18].…”

Section: Discussionmentioning

confidence: 99%

Risk factors of in-hospital death in pediatric patients with hemophagocytic lymphohistiocytosis: A case-control study

Zhang

Dai

2022

Preprint

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Background Early mortality in patients with hemophagocytic lymphohistiocytosis (HLH) remains largely high. The aim of our study was to comprehensively analyze the risk factors for in-hospital death in HLH patients. Methods A retrospective case-control study was conducted at West China Second Hospital of Sichuan University from January 2014 to December 2020. All pediatric patients diagnosed with HLH who were hospitalized for more than 24 hours were considered for inclusion. Collect demographic, laboratory, clinical, genetic profile, treatment information, and outcome data from records. Multivariable logistic regression models were used to evaluate the risk factors of in-hospital death. Results 150 pediatric patients with HLH were enrolled in the study. The median age of patients was 54 months (IQR 25–107) and 94 (62.7%) were men. The median length of hospital stay was 17 days (IQR 8-27.5). The overall in-hospital mortality rate for the cohort was 8%. Multivariable regression analysis showed that hyperlactatemia (OR = 8.018, 95%CI 1.202–53.471, p = 0.032) and CRRT (OR = 7.746, 95%CI 1.258–47.680, p = 0.027) were associated with higher risk of in-hospital mortality. Conclusions These data suggest that hyperlactatemia and CRRT use in pediatric patients with HLH were associated with increased in-hospital mortality.

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“…oXiris lter is super cially modi ed from an AN-69 membrane (polyacrylonitrile) with an additional positively charged polyimide ethylene layer used to enhance the cytokines-adsorbing capacity by ionic bonding and grafted with heparin (3), which was rst approved and marketed in Europe in 2009. The addition of the highly adsorptive preheparinized oXiris lter can enhance the ability of CRRT to effectively remove endotoxin, circulating cytokines, and in ammatory chemokines, thus reducing lactate concentration and vasopressors infusion rate, and improving haemodynamic status, systemic perfusion, multi-organ function, and clinical outcomes without related adverse events (3,31,32,35,37). Therefore, it gained emergency approval from US Food and Drug Administration (FDA) for the clinical treatment of COVID-19 in April 2020 to counter the CRS attack triggered by SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

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

Kang

Luo

Gao

et al. 2021

Preprint

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

show abstract

Continuous Renal Replacement Therapy with oXiris® Membrane in Severe Ebstein-Barr Virus-Mediated Hemophagocytic Lymphohistiocytosis: A Case Report

Cited by 4 publications

References 14 publications

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

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

Risk factors of in-hospital death in pediatric patients with hemophagocytic lymphohistiocytosis: A case-control study

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

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