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Open Access 01-12-2020 | Acute Kidney Injury | Research

Adsorption therapy in critically ill with septic shock and acute kidney injury: a retrospective and prospective cohort study

Authors: Gregor A. Schittek, Philipp Zoidl, Michael Eichinger, Simon Orlob, Holger Simonis, Martin Rief, Philipp Metnitz, Tobias Fellinger, Jens Soukup

Published in: Annals of Intensive Care | Issue 1/2020

Abstract

Background

Haemoadsorption has been described as an effective way to control increased pro- and anti-inflammatory mediators (“cytokine storm”) in septic shock patients. No prospective or randomised clinical study has yet confirmed these results. However, no study has yet prospectively specifically investigated patients in severe septic shock with sepsis-associated acute kidney injury (SA-AKI). Therefore, we aimed to examine whether haemoadsorption could influence intensive care unit (ICU) and hospital mortality in these patients. Furthermore, we examined the influence of haemoadsorption on length of stay in the ICU and therapeutic support.

Methods

Retrospective control group and prospective intervention group design in a tertiary hospital in central Europe (Germany). Intervention was the implementation of haemoadsorption for patients in septic shock with SA-AKI. 76 patients were included in this analysis.

Results

Severity of illness as depicted by APACHE II was higher in patients treated with haemoadsorption. Risk-adjusted ICU mortality rates (O/E ratios) did not differ significantly between the groups (0.80 vs. 0.83). We observed in patients treated with haemoadsorption a shorter LOS and shorter therapeutic support such as catecholamine dependency and duration of RRT. However, in multivariate analysis (logistic regression for mortality, competing risk for LOS), we found no significant differences between the two groups.

Conclusions

The implementation of haemoadsorption for patients in septic shock with acute renal failure did not lead to a reduction in ICU or hospital mortality rates. Despite univariate analysis delivering some evidence for a shorter duration of ICU-related treatments in the haemoadsorption group, these results did not remain significant in multivariate analysis.

Trial registration CytoSorb^® registry https://clinicaltrials.gov/ct2/show/NCT02312024. December 9, 2014. Database: https://www.cytosorb-registry.org/ (registration for content acquisition is necessary)

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Title: Adsorption therapy in critically ill with septic shock and acute kidney injury: a retrospective and prospective cohort study
Authors: Gregor A. Schittek
Philipp Zoidl
Michael Eichinger
Simon Orlob
Holger Simonis
Martin Rief
Philipp Metnitz
Tobias Fellinger
Jens Soukup
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keywords: Acute Kidney Injury
Septicemia
Septicemia
Septic Shock
Acute Kidney Injury
Published in: Annals of Intensive Care / Issue 1/2020
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-020-00772-7

At a glance: The STEP trials

Springer Medicine

Adsorption therapy in critically ill with septic shock and acute kidney injury: a retrospective and prospective cohort study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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