Evaluation of Clinical and Machine Data of Critically Ill Adult COVID Patients with Acute Kidney Injury Exposed to Enhanced Hemoadsorption during CRRT.

IF 2.2 3区医学 Q3 HEMATOLOGY Blood Purification Pub Date : 2024-01-01 Epub Date: 2023-12-16 DOI:10.1159/000535773

Augusto Cama-Olivares, Victor Ortiz-Soriano, Lucas J Liu, Stuart Carter, Tomonori Takeuchi, Jin Chen, Ashita J Tolwani, Javier A Neyra

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Abstract

Introduction: The FDA authorized the emergency use of enhanced hemoadsorption with oXiris in critically ill adult COVID patients with respiratory failure or severe disease to reduce inflammation. In this study, we evaluated critically ill adult COVID patients with acute kidney injury (AKI) who were exposed versus not exposed to enhanced hemoadsorption with oXiris during continuous renal replacement therapy (CRRT).

Methods: Retrospective cohort study of critically ill adult COVID patients with AKI requiring CRRT. Exposure to oXiris was defined as receiving oXiris for >12 cumulative hours and more than one-third of the time within the first 72 h of CRRT. Study outcomes included filter-specific performance metrics and clinical outcomes such as ventilator requirement, mortality, and dialysis dependence. Inverse probability treatment weighting was used to balance potential confounders in weighted regression models.

Results: 14,043 h of CRRT corresponding to 85 critically ill adult patients were analyzed. Among these, 2,736 h corresponded to oXiris exposure (n = 25 patients) and 11,307 h to a standard CRRT filter (n = 60 patients). Transmembrane pressures (TMPs) increased rapidly and were overall higher with oXiris versus standard filter, but filter life (median of 36.3 vs. 33.1 h, p = 0.913, respectively) and filter/clotting alarms remained similar in both groups. In adjusted models, oXiris exposure was not independently associated with the composite of hospital mortality and dialysis dependence at discharge (OR 2.13, 95% CI: 0.98-4.82, p = 0.06), but it was associated with fewer ventilator (β = -15.02, 95% CI: -29.23 to -0.82, p = 0.04) and intensive care unit days (β = -14.74, 95% CI: -28.54 to -0.95, p = 0.04) in survivors.

Discussion/conclusion: In critically ill adult COVID patients with AKI requiring CRRT, oXiris filters exhibited higher levels of TMP when compared to a standard CRRT filter, but no differences in filter life and filter/clotting alarm profiles were observed. The use of oXiris was not associated with improvement in clinical outcomes such as hospital mortality or dialysis dependence at discharge.

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评估在 CRRT 期间接受增强型血液吸附的 COVID 重症成人 AKI 患者的临床和机器数据。

背景：美国食品药品管理局（FDA）授权在呼吸衰竭或病情严重的成年 COVID 重症患者中紧急使用奥希瑞（oXiris）增强型吸血疗法，以减轻炎症反应。在这项研究中，我们评估了在持续肾脏替代疗法（CRRT）期间接受与未接受奥希瑞强化吸血疗法的急性肾损伤（AKI）成人 COVID 重症患者：方法：对患有急性肾损伤（AKI）、需要进行 CRRT 的 COVID 成年重症患者进行回顾性队列研究。接受奥希瑞的时间累计超过12小时，且三分之一以上的时间是在CRRT的前72小时内。研究结果包括过滤器特异性性能指标和临床结果，如呼吸机需求、死亡率和透析依赖性。在加权回归模型中使用了反概率治疗加权法来平衡潜在的混杂因素：结果：分析了 85 名成年重症患者的 14,043 小时 CRRT。其中，2,736 个小时与奥希瑞接触（25 例患者），11,307 个小时与标准 CRRT 过滤器接触（60 例患者）。跨膜压力（TMP）迅速升高，总体而言，使用奥希瑞斯比使用标准过滤器更高，但两组的过滤器寿命（中位数分别为 36.3 小时和 33.1 小时，P=0.913）和过滤器/凝血警报仍然相似。在调整后的模型中，奥希瑞暴露与住院死亡率和出院时透析依赖的综合指数（OR 2.13，95% CI 0.98-4.82，p=0.06）无独立关联，但与幸存者呼吸机（β = -15.02，95% CI -29.23至-0.82，p=0.04）和重症监护室（β = -14.74，-28.54至-0.95，p=0.04）天数的减少有关：在需要进行CRRT的重症COVID成人AKI患者中，与标准CRRT滤器相比，oXiris滤器的TMP水平更高，但在滤器寿命和滤器/凝血警报曲线方面未观察到差异。使用 oXiris 与住院死亡率或出院时的透析依赖性等临床结果的改善无关。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.