Reliability of biomarkers of sepsis during extracorporeal therapies: the clinician needs to know what is eliminated and what is not

Honoré, Patrick M.; Redant, Sebastien; Bels, David De

doi:10.1186/s13054-020-03277-8

Cited by 19 publications

(21 citation statements)

References 15 publications

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“…Additionally, CVVH may remove certain biomarkers and give clinicians a false sense of security regarding the patients’ clinical status. These removable biomarkers include C-reactive protein monomer, procalcitonin, and brain natriuretic peptide ( 46 ). Finally, CVVH, especially at higher doses can remove essential electrolytes mandating close monitoring and replacement.…”

Section: Lessons Learned Applicability To Covid-19 and Future Directmentioning

confidence: 99%

New Decade, Old Debate: Blocking the Cytokine Pathways in Infection-Induced Cytokine Cascade

Rizvi

Moraes

2021

Critical Care Explorations

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Objectives: Our understanding of the immunopathogenesis of coronavirus disease 2019 is evolving; however, a “cytokine storm” has been implicated. Ongoing clinical trials are evaluating the value of anticytokine therapies to treat patients with coronavirus disease 2019. This review summarizes the existing literature evaluating the efficacy and safety of anticytokine therapy to tackle the dysregulated immune response to infectious pathogens, discusses potential reasons for failure, applicability to coronavirus disease 2019, and future direction. Data Sources: Medline, PubMed, ClinicalTrials.gov , and media reports. Study Selection: The studies were included by author consensus. Data Extraction: Data were selected for inclusion after reviewing each study by author consensus. Data Synthesis: “Cytokine storm” is a nonspecific term, encompassing systemic inflammatory response to infectious pathogens, autoimmune conditions, cancers, trauma, and various chemotherapies. Like bacterial sepsis, viral pathogens may fuel immunopathogenesis by inducing a dysregulated autoamplifying cytokine cascade, ultimately leading to organ injury. This narrative review discusses what we know of the immune milieu of coronavirus disease 2019 versus noncoronavirus disease 2019 sepsis and/or acute respiratory distress syndrome, summarizes the existing literature on cytokine inhibitors in patients with sepsis and/or acute respiratory distress syndrome, and discusses possible reasons for recurrent failure. In doing so, it aims to assist decisions regarding the use of anticytokine therapy in patients with coronavirus disease 2019, as many regions of the world confront the second wave of the pandemic. Conclusions: As ongoing clinical trials determine the efficacy and safety of anticytokine therapy in patients with coronavirus disease 2019, clinicians should uphold caution when incorporating it into treatment protocols, while maintaining focus on established evidence-based practices and the mantra of “less is more.”

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Section: Lessons Learned Applicability To Covid-19 and Future Directmentioning

confidence: 99%

New Decade, Old Debate: Blocking the Cytokine Pathways in Infection-Induced Cytokine Cascade

Rizvi

Moraes

2021

Critical Care Explorations

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“…Indeed seeing the severity of these cardiogenic patients and the high incidence of AKI at baseline and at 12 h, clearly some patients were upon RRT or CRRT (seeing the high prevalence of vasopressors) within the first 12 to 24 h [1]. P-NGAL is a secretory protein whose molecular weight (MW) is 25,000 dalton (Da) as a monomer [2]. P-PENK has a MW of 4586 Da [2].…”

mentioning

confidence: 99%

“…P-NGAL is a secretory protein whose molecular weight (MW) is 25,000 dalton (Da) as a monomer [ 2 ]. P-PENK has a MW of 4586 Da [ 2 ]. The contemporary CRRT membranes are able to remove molecules as large as 35,000 Da [ 3 ].…”

mentioning

confidence: 99%

High levels of plasma biomarkers at 24 h were found to be strong predictors of 90-day mortality: beware of some potential confounders!

Honoré

Redant

Préseau

et al. 2021

Ann. Intensive Care

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“…Misinterpretation of the results can lead to the wrong conclusions. PE has a cutoff of 1,000,000 Da (Da) and can therefore remove many substances [ 2 ]. Let us just take the example of the inflammatory mediators C-reactive protein (CRP) and interleukin-6 (IL-6).…”

mentioning

confidence: 99%

“…Let us just take the example of the inflammatory mediators C-reactive protein (CRP) and interleukin-6 (IL-6). CRP, in its pentameric form, has a molecular weight of 120,000 Da and IL-6 has a molecular weight of 21,000 Da [ 2 ]. It stands to reason that these two inflammatory molecules will be easily removed by TPE.…”

mentioning

confidence: 99%

Are SOFA score, PaO2/FiO2 ratio, lymphocytes levels, total bilirubin, lactate dehydrogenase, ferritin, C-reactive protein and interleukin-6 significantly normalized following TPE completion: Is this fact or fiction?

Honoré

Redant

Préseau

et al. 2021

Journal of Critical Care

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Reliability of biomarkers of sepsis during extracorporeal therapies: the clinician needs to know what is eliminated and what is not

Cited by 19 publications

References 15 publications

New Decade, Old Debate: Blocking the Cytokine Pathways in Infection-Induced Cytokine Cascade

New Decade, Old Debate: Blocking the Cytokine Pathways in Infection-Induced Cytokine Cascade

High levels of plasma biomarkers at 24 h were found to be strong predictors of 90-day mortality: beware of some potential confounders!

Are SOFA score, PaO2/FiO2 ratio, lymphocytes levels, total bilirubin, lactate dehydrogenase, ferritin, C-reactive protein and interleukin-6 significantly normalized following TPE completion: Is this fact or fiction?

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