oXiris® Use in Septic Shock: Experience of Two French Centres

Abstract

Background: Sepsis is a dysregulated host response to an infection and can result in organ dysfunctions and death. Extracorporeal blood purification techniques aim to improve the prognosis of these patients by modulating the unbalanced immune response. This study reports our experience with the use of the oXiris® membrane for septic shock patients requiring continuous renal replacement therapy (CRRT). Summary: Thirty-one patients were diagnosed with septic shock and underwent CRRT with the oXiris® membrane between 2014 and 2019. We compared the observed hospital mortality with that predicted by the Simplified Acute Physiology Score II (SAPS II). Change in the Sequential Organ Failure Assessment (SOFA) score and of the main clinical and biological parameters over time were analyzed. Hospital mortality was lower than predicted for the most severe patients (60 vs. 91% for the [74–87] SAPS II quartile and 70 vs. 98% for the [87–163] SAPS II quartile, p < 0.02). There was no significant improvement in the SOFA score from 0h to 48 h. An 88% relative decrease in norepinephrine infusion was observed (median at 0 h was 1.69 [0.52–2.45] µg/kg/min; at 48 h it was 0.20 [0.09–1.14] µg/kg/min, p = 0.002). Lactataemia and pH were significantly improved over time. Patients with intra-abdominal sepsis as well as those with Gram-negative bacilli (GNB) infections seemed to benefit the most from the therapy. Key Messages: CRRT with the oXiris® haemofilter resulted in higher observed survival than predicted by a severity score (SAPS II) for the most severe patients. Haemodynamic status and lactataemia appeared to improve, especially in intra-abdominal sepsis and GNB infections.

Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19

“…Emerging evidence indicates the potential benefits of managing cytokine storm, via using steroid or IL-6/ IL-6-receptor blocking antibodies [3,6]. The capability of blood purification therapy in removing pathogenic antibodies or cytokines has been proven in multiple scenarios, but not in COVID-19 patients [7,8].…”

Evaluation of the Effectiveness of Continuous Venovenous Hemodiafiltration Appli̇ed With Oxiris and AN69 Membranes in Patients With Septic Shock-Related Acute Kidney Injury

“…Oxiris is a high permeability polyacrylonitrile (AN69) based membrane on which a surface treatment of a positively charged polyethylene is added onto the hemofilter. Thanks to this positive charge on the surface of the Oxiris filter -in addition to the bulk cytokine elimination in the mass of the membrane -endotoxin (negatively charged) adsorption takes place (13). In in-vitro studies, Oxiris filter emerges as a hemoperfusion device capable of eliminating both endotoxin and cytokine (29).…”

“…A relative decrease of 88% was observed in NIR. Lactatemia and pH improved significantly over time (13). In their study on 60 septic patients published in 2019, Turani et al found that CVVHDF with Oxiris filter improved basic cardiorenal and respiratory parameters and decreased NIR (31).…”

“…AN69 adsorbs cytokines but does not adsorb endotoxins (12). Oxiris adsorbs endotoxins (negatively charged) thanks to the positive charge on the surface in addition to cytokine elimination (13). Most studies of Oxiris include patients with sepsis/septic shock due to gram-negative bacteria.…”

Prescription of CRRT: a pathway to optimize therapy

“…Nevertheless, there was an 88% relative decrease in norepinephrine infusion (with stabilization of hemodynamic status) and a significant improvement in lactatemia and pH over time. These improvements were most evident in patients with intraabdominal sepsis and those with Gram-negative bacilli infection [95]. In a larger recent study, the medical records of 60 septic patients treated with CRRT using the oXiris set from April 2011 to December 2018 were reviewed-85% of patients had AKI.…”