Introduction:
Sepsis is marked by dysregulated inflammatory cytokines and endotoxins leading to hemodynamic alterations and multi-organ failure. Extracorporeal blood purification therapies like Continuous Renal Replacement Therapy (CRRT) with cytokine filters are aimed to modulate the unbalanced immune response and improve outcome. We compared the clinical benefits of cytokine adsorption filter over standard filter in CRRT in critically ill septic patients.
Methods:
36 patients admitted between September 2022 to February 2024 in ICU at Max-Alexis Hospital, Nagpur were included in this prospective comparative study. Patients above 18 years age who were critically ill as evident from SOFA score 2 or more, AKIN stage 3, on vasopressor support and who were in need of CRRT were inculcated in the study. Pregnant patients, lactating females and patients who did not complete 24 hours of treatment with CRRT were excluded. Patient were divided in 2 groups, one who received standard CRRT and other who received CRRT with cytokine absorption filter decided by the Nephrologist. Serial monitoring for hemodynamic stability (Vasoactive ionotropic score), sickness scores (SOFA, APACHE II) and inflammatory markers (Procalcitonin, CRP, lactates, Interleukin-6, TNF-α) was done at 24 and 48 hours. Objectives – To compare the change in the hemodynamic stability scores and inflammatory markers in critically ill patients on CRRT when treated with cytokine filter vs standard CRRT filter.
Results:
SOFA score decreased from onset to 48 hours in both the filters (cytokine- 14.98 to 12) (standard- 15.97 to 11.34), but there was no statistically significant difference between them. APACHE II score decreased from onset to 48 hours in both the filters (cytokine- 26.55 to 22.83) (standard- 24.5 to 17.83), but there was no statistically significant difference between them. Inflammatory factors like Procalcitonin, CRP and Lactates improved significantly with the cytokine filter (p<0.05). Interleukin-6 levels decreased from onset to 48 hours in both the filters (cytokine- 132.23 to 98.94, P<0.001) (standard- 346.9 to 118.37, P<0.001) but there was no statistically significant difference between them. TNF-α decreased from onset to 48 hours in both the filters (cytokine- 84.06 to 45.06, P<0.001) (standard- 53.39 to 10.28, P<0.001) but there was no statistically significant difference between them. Vasoactive Ionotropic score decreased significantly from onset to 48 hours in both filters (cytokine- 27.02 to 10.06, p<0.001) (standard- 24.01 to 11.72, p<0.001) and there was significant difference between them.
Conclusions:
This study concluded a significant improvement in hemodynamic stability with the cytokine filter over the standard filter in CRRT. The sickness scores (SOFA and APACHE II), IL-6 levels and TNF-α levels showed significant improvement with both the filters, but there was no significant difference between them. There was also improvement in inflammatory markers when cytokine filter was used as compared to standard CRRT filter. This shows that cytokine adsorption filter can help in reducing the overall severity of illness thereby providing additional time for definitive treatment.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.