1
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Hemoadsorption in the critically ill—Final results of the International CytoSorb Registry

      research-article
      1 , * , , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55
      PLOS ONE
      Public Library of Science

      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The aim of the current paper is to summarize the results of the International CytoSorb Registry. Data were collected on patients of the intensive care unit. The primary endpoint was actual in-hospital mortality compared to the mortality predicted by APACHE II score. The main secondary endpoints were SOFA scores, inflammatory biomarkers and overall evaluation of the general condition. 1434 patients were enrolled. Indications for hemoadsorption were sepsis/septic shock (N = 936); cardiac surgery perioperatively (N = 172); cardiac surgery postoperatively (N = 67) and “other” reasons (N = 259). APACHE-II-predicted mortality was 62.0±24.8%, whereas observed hospital mortality was 50.1%. Overall SOFA scores did not change but cardiovascular and pulmonary SOFA scores decreased by 0.4 [-0.5;-0.3] and -0.2 [-0.3;-0.2] points, respectively. Serum procalcitonin and C-reactive protein levels showed significant reduction: -15.4 [-19.6;-11.17] ng/mL; -17,52 [-70;44] mg/L, respectively. In the septic cohort PCT and IL-6 also showed significant reduction: -18.2 [-23.6;-12.8] ng/mL; -2.6 [-3.0;-2.2] pg/mL, respectively. Evaluation of the overall effect: minimal improvement (22%), much improvement (22%) and very much improvement (10%), no change observed (30%) and deterioration (4%). There was no significant difference in the primary outcome of mortality, but there were improvements in cardiovascular and pulmonary SOFA scores and a reduction in PCT, CRP and IL-6 levels.

          Trial registration: ClinicalTrials.gov Identifier: NCT02312024 (retrospectively registered).

          Related collections

          Most cited references41

          • Record: found
          • Abstract: found
          • Article: not found

          APACHE II: a severity of disease classification system.

          This paper presents the form and validation results of APACHE II, a severity of disease classification system. APACHE II uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status to provide a general measure of severity of disease. An increasing score (range 0 to 71) was closely correlated with the subsequent risk of hospital death for 5815 intensive care admissions from 13 hospitals. This relationship was also found for many common diseases. When APACHE II scores are combined with an accurate description of disease, they can prognostically stratify acutely ill patients and assist investigators comparing the success of new or differing forms of therapy. This scoring index can be used to evaluate the use of hospital resources and compare the efficacy of intensive care in different hospitals or over time.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Circulating Mitochondrial DAMPs Cause Inflammatory Responses to Injury

            Injury causes a systemic inflammatory response syndrome (SIRS) clinically much like sepsis 1. Microbial pathogen-associated molecular patterns (PAMPs) activate innate immunocytes through pattern recognition receptors 2. Similarly, cellular injury can release endogenous damage-associated molecular patterns (DAMPs) that activate innate immunity 3. Mitochondria are evolutionary endosymbionts that were derived from bacteria 4 and so might bear bacterial molecular motifs. We show here that injury releases mitochondrial DAMPs (MTD) into the circulation with functionally important immune consequences. MTD include formyl peptides and mitochondrial DNA. These activate human neutrophils (PMN) through formyl peptide receptor-1 and TLR9 respectively. MTD promote PMN Ca2+ flux and phosphorylation of MAP kinases, thus leading to PMN migration and degranulation in vitro and in vivo. Circulating MTD can elicit neutrophil-mediated organ injury. Cellular disruption by trauma releases mitochondrial DAMPs with evolutionarily conserved similarities to bacterial PAMPs into the circulation. These can then signal through identical innate immune pathways to create a sepsis-like state. The release of such mitochondrial ‘enemies within’ by cellular injury is a key link between trauma, inflammation and SIRS.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy.

              Sepsis - which is a severe life-threatening infection with organ dysfunction - initiates a complex interplay of host pro-inflammatory and anti-inflammatory processes. Sepsis can be considered a race to the death between the pathogens and the host immune system, and it is the proper balance between the often competing pro- and anti-inflammatory pathways that determines the fate of the individual. Although the field of sepsis research has witnessed the failure of many highly touted clinical trials, a better understanding of the pathophysiological basis of the disorder and the mechanisms responsible for the associated pro- and anti-inflammatory responses provides a novel approach for treating this highly lethal condition. Biomarker-guided immunotherapy that is administered to patients at the proper immune phase of sepsis is potentially a major advance in the treatment of sepsis and in the field of infectious disease.
                Bookmark

                Author and article information

                Contributors
                Role: Data curationRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: Formal analysisRole: Methodology
                Role: ConceptualizationRole: Funding acquisitionRole: Writing – original draft
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: Methodology
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                25 October 2022
                2022
                : 17
                : 10
                : e0274315
                Affiliations
                [1 ] Department of Anesthesiology and Intensive Care, University of Szeged, Szeged, Hungary
                [2 ] Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Bucharest, Romania
                [3 ] Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
                [4 ] Kardioanasthesiologie, Universitätsklinikum Ulm, Ulm, Germany
                [5 ] Universitätsklinikum der LMU München, Herzchirurgische Klinik und Poliklinik, Munich, Germany
                [6 ] Klinik für Anästhesiologie und Intensivmedizin, Hans-Susemihl-Krankenhaus GmbH, Emden, Germany
                [7 ] Klinik für Anästhesiologie, Intensivtherapie und Palliativmedizin, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
                [8 ] Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Germany
                [9 ] Universitätsklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Germany
                [10 ] Herz- und Diabeteszentrum NRW, Klinische Studien Chirurgie, Bad Oeynhausen, Germany
                [11 ] Kliniken Nordoberpfalz AG, Klinikum Weiden, Weiden, Germany
                [12 ] Research Hospital "Casa Sollievo della Sofferenza" Medical Science, Nephrology and Dialysis Unit, San Giovanni, Rotondo, Italy
                [13 ] Ziekenhuis De Tjongerschans, Heerenveen, Netherlands
                [14 ] First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
                [15 ] Medical Data Management, Medaman, Geel, Belgium
                [16 ] International Fluid Academy, Lovenjoel, Belgium
                [17 ] Klinik für Anästhesiologie, AG Hämodynamik, Klinikumrechts der Isar TU München, München, Germany
                [18 ] Krankenhaus Hietzing, Wiener Krankenanstaltenverbund, A, Wien, Austria
                [19 ] Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Region Hannover Nordstadt, Hannover, Germany
                [20 ] Universitätsklinikum Freiburg, Abteilung Allgemein- und Viszeralchirurgie, Freiburg, Germany
                [21 ] Klinik für Intensivmedizin, Universitätsklinikum Hamburg- Eppendorf, Hamburg, Germany
                [22 ] Klinik für Anästhesie, Intensiv-, Palliativ- und Schmerzmedizin, Berufsgenossensch Uniklinik Bergmannsheil, Bochum, Germany
                [23 ] Krankenhaus BHS Ried im Innkreis, Ried im Innkreis, Austria
                [24 ] Klinikum Herford, UK Anästhesie, Intensivmedizin, Rettungsmedizin, Schmerztherapie, Herford, Germany
                [25 ] Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
                [26 ] Krankenhaus Martha Maria Halle Klinik für Anaesthesiologie und Intensivmedizin, Halle, Germany
                [27 ] Klinik für Anästhesiologie, Intensiv-, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany
                [28 ] Krankenhaus Düren gem. GmbH, Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Düren, Germany
                [29 ] Universitätsklinik für Anästhesiologie/Intensiv-/Notfallmedizin/Schmerztherapie, Klinikum Oldenburg GmbH, Carl von Ossietzky Universität, Oldenburg, Germany
                [30 ] Heinrich Braun Klinikum Zwickau, Zwickau, Germany
                [31 ] Klinikum Wolfsburg, Klinik für Anästhesie und Intensivmedizin, Wolfsburg, Germany
                [32 ] Klinikum Oberlausitzer Bergland GmbH, Zittau, Germany
                [33 ] University Medical Centre Ljubljana, Dep. Of Internal medicine, ICU, Ljubljana, Slovenia
                [34 ] Klinik für Kardiologie und Intensivmedizin, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
                [35 ] Zentrum Anästhesiologie, Rettungs-und Intensivmedizin, Universitätsklinikum Göttingen, Göttingen, Germany
                [36 ] GPR Klinikum Rüsselsheim, Abteilung Anästhesie, Rüsselsheim, Germany
                [37 ] Universitätsklinikum Jena, Klinik für Anästhesiologie und Intensivmedizin, Jena, Germany
                [38 ] Medizinische Klinik und Poliklinik II, Klinikum der Universität München, München, Germany
                [39 ] Rianimazione Ospedale U. Parini, S.C. Anestesia e Rianimazione, Aosta, Italy
                [40 ] Kliniken Erlabrunn gGmbH, Erlabrunn, Germany
                [41 ] Klinik für Anästhesie, Intensiv-, Notfallmedizin und Schmerztherapie, Krankenhaus St. Elisabeth und St. Barbara, Halle, Germany
                [42 ] Krankenhaus Herzberg, Elbe-Elster-Klinikum GmbH, Herzberg, Germany
                [43 ] Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
                [44 ] Klinik für Pneumologie, Gastroenterologie, Internistische Intensiv- und Beatmungsmedizin, Städtisches Klinikum München GmbH, Klinikum Harlaching, Munich, Germany
                [45 ] Universitätsklinikum Regensburg, Klinik für Anästhesiologie, Regensburg, Germany
                [46 ] Fachkrankenhaus Coswig, Klinik für Anästhesiologie und Intensivmedizin, Coswig, Germany
                [47 ] Bodden Kliniken Ribnitz Damgarten, Ribnitz Damgarten, Germany
                [48 ] Diakovere Friederikenstift, Hannover, Germany
                [49 ] Center for Clinical Studies Jena (ZKS), Jena University Hospital, Jena, Germany
                [50 ] Doctoral School of Multidisciplinary Medical Sciences, University of Szeged, Szeged, Hungary
                [51 ] Institute for Translational Medicine, School of Medicine, University of Pécs, Pécs, Hungary
                [52 ] Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
                [53 ] Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
                [54 ] Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
                [55 ] Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
                IRCCS Policlinico S.Donato, ITALY
                Author notes

                Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: KT has received honoraria for lectures and consultations from CytoSorbents Europe (Berlin, Germany); KK has received honoraria for lectures and consultations from CytoSorbents Europe (Berlin, Germany); AF has received honoraria for lectures and consultations from CytoSorbents Europe (Berlin, Germany); FMB has received honoraria for lectures and consultations from CytoSorbents Europe (Berlin, Germany); ZM has received honoraria for lectures and consultations and he also functions as medical director at CytoSorbents Europe (Berlin, Germany). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                ‡ FH and DT contributed equally to this work as first authors.

                Author information
                https://orcid.org/0000-0001-8015-5966
                https://orcid.org/0000-0001-9673-5754
                https://orcid.org/0000-0001-5907-7895
                https://orcid.org/0000-0001-7634-166X
                https://orcid.org/0000-0003-4657-4942
                https://orcid.org/0000-0002-1373-1027
                Article
                PONE-D-21-27016
                10.1371/journal.pone.0274315
                9595535
                36282800
                a681472d-bb68-46d1-9a27-9c4dcfc69f3d
                © 2022 Hawchar et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 August 2021
                : 25 August 2022
                Page count
                Figures: 3, Tables: 4, Pages: 17
                Funding
                The authors received no specific funding for this work. The funder provided support in the form of research material but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials. KT, KK, AF, FB and ZM received honoraria for lectures and consultations from CytoSorbents Europe (Berlin, Germany), ZM also functions as a medical director at CytoSorbents Europe (Berlin, Germany).
                Categories
                Research Article
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Sepsis
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Cardiovascular Procedures
                Cardiac Surgery
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Physicians
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Physicians
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Hospitals
                Intensive Care Units
                Biology and Life Sciences
                Immunology
                Immune Response
                Inflammation
                Medicine and Health Sciences
                Immunology
                Immune Response
                Inflammation
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Inflammation
                Research and Analysis Methods
                Research Design
                Clinical Research Design
                Case Series
                Biology and Life Sciences
                Biochemistry
                Proteins
                C-Reactive Proteins
                People and places
                Geographical locations
                Europe
                European Union
                Germany
                Custom metadata
                The data are not publicly available due to privacy or ethical restrictions, since data contain potentially identifying or sensitive patient information. The data that support the findings of this study are available on request to the Center of Clinical Studies at Jena University Hospital (JUH), Salvador-Allende-Platz 27, 07747 Jena, Germany. E-mail: zks@ 123456med.uni-jena .

                Uncategorized
                Uncategorized

                Comments

                Comment on this article