Albumin and platelet loss during the application of CytoSorb® in critically ill patients: a post-hoc analysis of the Cyto-SOLVE trial.

IF 2.2 3区医学 Q3 HEMATOLOGY Blood Purification Pub Date : 2024-11-07 DOI:10.1159/000542009

Clara Isabell Brozat, Michael Zoller, Sandra Frank, Mathias Bruegel, Caroline Gräfe, Diana Rebholz, Michael Paal, Helen Graf, Uwe Liebchen, Christina Scharf

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Abstract

Introduction: Adsorption devices like CytoSorb® (CS) are increasingly used in critically ill patients. However, potential adverse effects have not been sufficiently investigated. The aim of this post-hoc analysis of the monocentric prospective Cyto-SOLVE study was to examine albumin concentration and platelet count during the application of CS in intensive care unit (ICU) patients with different indications for CS therapy.

Methods: 29 Adult ICU patients receiving continuous kidney replacement therapy and CS application for 12 hours were included. Albumin concentration and platelet count were measured before, during, and after application. Changes in albumin concentration and platelet count were investigated. Since 10/29 patients were substituted with platelets during CS therapy and 20/29 received albumin, subgroup analysis was performed in patients receiving no platelet concentrate and <20g albumin substitution during CS application. The dependent sample t-test was used to detect significant (p<0.05) changes over time and multivariate models were investigated.

Results: We observed a significant reduction in platelets (p=0.005, mean 14 G/l, 95% confidence interval (CI) 4 - 23G/l) during CS therapy with an even more pronounced drop in those 19 patients without platelet substitution (p=0.001, mean 22G/l, 95% CI 10 - 34). No significant change was detected in the albumin concentration of all patients. However, a significant albumin decrease was observed in those 17 patients with less than 20g albumin substitution during CS therapy (p=0.007, mean 0.17g/dL, 95% CI 0.05 - 0.29). No other potential covariates for the decrease could be identified in a multivariate model.

Conclusion: Since a drop in albumin and platelets occurred during the use of CS, an increased substitution might be necessary. Knowledge of potential side effects is of great importance to prevent harm during the use of extracorporeal procedures. This knowledge should be considered for a reliable risk-benefit assessment in the future.

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重症患者使用 CytoSorb® 期间的白蛋白和血小板损失：Cyto-SOLVE 试验的事后分析。

介绍：CytoSorb®（CS）等吸附装置越来越多地用于重症患者。然而，潜在的不良反应尚未得到充分研究。本研究是对单中心前瞻性 Cyto-SOLVE 研究的事后分析，目的是检查重症监护病房（ICU）患者在使用 CS 期间的白蛋白浓度和血小板计数，这些患者的 CS 治疗适应症各不相同。在使用 CS 之前、期间和之后测量白蛋白浓度和血小板计数。调查白蛋白浓度和血小板计数的变化。由于 10/29 例患者在 CS 治疗期间使用血小板替代，20/29 例患者使用白蛋白，因此对未使用血小板浓缩物的患者进行了亚组分析：我们观察到，在 CS 治疗期间，血小板明显减少（p=0.005，平均 14G/l，95% 置信区间（CI）4 - 23G/l），19 例未使用血小板替代品的患者血小板下降更为明显（p=0.001，平均 22G/l，95% 置信区间（CI）10 - 34）。所有患者的白蛋白浓度均无明显变化。然而，在 CS 治疗期间，白蛋白替代量低于 20 克的 17 名患者的白蛋白出现了明显下降（p=0.007，平均 0.17 克/分升，95% CI 0.05 - 0.29）。在多变量模型中未发现导致白蛋白下降的其他潜在协变量：结论：由于在使用 CS 期间白蛋白和血小板会下降，因此可能有必要增加替代品。了解潜在的副作用对防止使用体外循环过程中的伤害非常重要。今后在进行可靠的风险效益评估时，应考虑到这些知识。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.