Effect Of Continuous Renal Replacement Therapy With Oxiris Filter On Hemodynamics In Patients With Septic Shock:a Single-center Retrospective Cohort Study

BackgroundSepsis is a life-threatening organ dysfunction caused by the host’s maladjusted response to infection.Due to the high incidence,high mortality,high cost and complex mechanism of sepsis,it is extremely important to solve this problem or promote the development of related treatment programs.The development of sepsis is essentially a cytokine storm,so it is very important to remove endotoxins and excess cytokines from the body’s blood circulation and re-establish a regulated immune response.Continuous renal replacement therapy(CRRT)is a slow and steady blood purification therapy that non-selectively removes pro-inflammatory and anti-inflammatory mediators,slows the pro-inflammatory and anti-inflammatory cascade of eruptions,and maintains hemodynamic stability.In particular,oXiris filters can absorb both endotoxins and cytokines,which may be more beneficial to the prognosis of sepsis patients.Therefore,the objective of this study was to explore the outcome of oXiris filter continuous renal replacement therapy in patients with septic shock.ObjectiveTo explore the effect of oXiris filter continuous renal replacement therapy on hemodynamics in septic shock patients and whether oXiris filter continuous renal replacement therapy can improve all-cause mortality in septic shock patients.MethodsIn this single-center retrospective cohort study,345 patients who met the 2016 international consensus diagnostic criteria for septic shock were enrolled through screening and scheduling.There were 165 patients in the oXiris group and 180 patients in the control group according to whether they received continuous renal replacement therapy with Oxiris filter during hospitalization.The main outcome index was the hemodynamic level of the patients.Secondary outcome indicators included 7-day,14-day,28-day and 90-day all-cause mortality,inflammation evaluation index,severity evaluation index,organ function support evaluation index,organ function improvement evaluation index,length of stay,hospitalization cost,and use of filter during hospitalization,etc.ResultA total of 345 patients who met the exclusion criteria from June 30,2020 to March 23,2022 were included in the study.After adjusting for the difference between groups,the total study population was 188,with 94 patients in the oXiris group and 94 in the control group,after 1:1 matching(PSM).The main outcome was that the 72-hour norepinephrine pump velocity(0.2 vs 0.1,P=0.01)and vasoactive drug score(20 vs 10,P=0.011)of the oXiris group were improved compared with the control group,and there were statistical differences.But there was no significant difference in mortality between the oXiris group and the control group.There were no significant differences in the secondary indexes,i.e.,most inflammation indexes,disease severity indexes,organ function support indexes,organ function improvement evaluation indexes and length of stay between the oXiris group and the control group within 3 days after enrollment.ConclusionAccording to the results of this study,continuous renal replacement therapy with oXiris filter cannot be considered to improve the mortality of patients with septic shock,but it can be expected to improve the circulatory function and hemodynamic level of patients to some extent.In general,patients with mild disease who use oXiris filters may have a better long-term prognosis.Multicenter,large sample,randomized controlled trials are still needed to validate the effect of oXiris filter on continuous renal replacement therapy in patients with septic shock.