A retrospective study in adult patients with septic shock and multiple organ failure demonstrated improved 28-day survival with adjunct TPE compared to standard care alone: true effect or mediated by a negative fluid balance achieved by RRT?

Abstract Background: Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence for therapeutic plasma exchange (TPE) in this setting is promising but inconclusive. Our study aims to evaluate the efficacy of adjunct TPE for septic shock with multiple organ failure compared to standard therapy alone. Methods: A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine resistant septic shock and multiple organ failure in Intensive Care Units at a tertiary care hospital in Winston Salem, North Carolina from August 2015- March 2019. Adult patients with catecholamine resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using age, gender, chronic co-morbidities (HTN, DM, CKD, COPD), APACHE II score, SOFA score, lactate level, and number of vasopressors was used to match patients, resulting in 40 patients in each arm. Results: Mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients. The 28-day mortality rate was 40% in the TPE group versus 65% in the standard care group (p=0.043). Improvements in baseline SOFA scores at 48 hours were greater in the TPE group compared to standard care alone (p=0.001), and patients receiving adjunct TPE had a more favorable fluid balance at 48 hours (p=0.01). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay (p=0.003 and p=0.006). Conclusions: Our retrospective, observational study in adult patients with septic shock and multiple organ failure demonstrated improved 28-day survival with adjunct TPE compared to standard care alone. Hemodynamics, organ dysfunction, and fluid balance all improved with adjunct TPE, while lengths of stay were increased in survivors. The study design does not allow for a generalized statement of support for TPE in all cases of sepsis with multiple organ failure but offers valuable information for a prospective, randomized clinical trial.

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The Therapeutic Efficacy of Adjunct Therapeutic Plasma Exchange for Septic Shock with Multiple Organ Failure: A Single Center Retrospective Review

10.21203/rs.3.rs-16022/v1 ◽

2020 ◽

Cited By ~ 2

Author(s):

Philip Keith ◽

Adam H Wells ◽

Jeremy Hodges ◽

Stephen H Fast ◽

Amber Adams ◽

...

Keyword(s):

Septic Shock ◽

Mortality Rate ◽

Multiple Organ Failure ◽

Organ Failure ◽

Plasma Exchange ◽

Standard Care ◽

Multiple Organ ◽

Therapeutic Plasma Exchange ◽

Adult Patients ◽

Apache Ii

Abstract Background: Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence behind therapeutic plasma exchange in this setting is promising but inconclusive. Our study aims to evaluate the efficacy of adjunct therapeutic plasma exchange for septic shock with multiple organ failure compared to standard therapy alone. Methods: A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine resistant septic shock and multiple organ failure in Intensive care units at a tertiary care hospital in Winston Salem, North Carolina from August 2015- March 2019. Adult patients with catecholamine resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure (lactic acid >2, platelets < 200, and pH < 7.3) were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using APACHE II score, SOFA score, and age was used to match patients, resulting in 40 patients in each arm. Results: Mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients. The 28-day mortality rate was 40% in the TPE group versus 62.5% in the standard care group (p=0.07). The subgroup of patients with pneumonia as the primary diagnosis had a 28-day mortality rate of 47.8% with adjunct TPE compared 81.3% with standard care alone (p = 0.05). Improvements in baseline SOFA scores at 48 hours were greater in the TPE group compared to standard care alone (p= 0.001). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay. Conclusions: Our retrospective, observational study in adult patients with septic shock and multiple organ failure did not show improvement with adjunct TPE except in patients with pneumonia as the primary source of sepsis. Hemodynamics and organ dysfunction did improve with TPE regardless of source. A prospective, randomized clinical trial is needed to investigate TPE in adult sepsis and to identify subgroups that are most likely to benefit.

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In Reference to Risk Perception of Septic Shock with Multiple Organ Failure Due to Acute Exacerbation of an Infectious Dental Disease [Letter]

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s342486 ◽

2021 ◽

Vol Volume 17 ◽

pp. 1163-1164

Author(s):

Yuh Baba ◽

Satoshi Takada ◽

Yasumasa Kato

Keyword(s):

Septic Shock ◽

Risk Perception ◽

Multiple Organ Failure ◽

Organ Failure ◽

Acute Exacerbation ◽

Multiple Organ ◽

Dental Disease

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Improving the therapy of generalized forms of Meningococcal infection in children using extracorporeal hemocorrection

CHILDREN INFECTIONS ◽

10.22627/2072-8107-2021-20-2-49-56 ◽

2021 ◽

Vol 20 (2) ◽

pp. 49-56

Author(s):

K. V. Markova ◽

E. Yu. Skripchenko ◽

K. V. Serednyakov ◽

Yu. V. Lobzin ◽

N. V. Skripchenko ◽

...

Keyword(s):

Septic Shock ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ ◽

Meningococcal Infection ◽

Basic Drug ◽

Inflammatory Reactions ◽

Clinical Center ◽

Refractory Septic Shock ◽

Group 2

Invasive meningococcal infection is a significant cause of death, reaching 80% in septic shock. The Pediatric Research and Clinical Center for Infectious Diseases (PRCCID) has developed an algorithm for the treatment of children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome, which includes basic drug therapy with polymyxin hemoperfusion in combination with extended methods of extracorporeal hemocorrection.Purpose: to evaluate the effectiveness of extracorporeal hemocorrection operations in children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome.Materials and research methods: to the intensive care unit of the PRCCID for the analyzed period 2006—2020 34 children were hospitalized with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome. Two groups were formed: Group 1 — children admitted to the PRCCID in the period 2014—2020 (n = 23), who underwent polymyxin hemoperfusion simultaneously with extended methods of extracorporeal hemocorrection, group 2 — children hospitalized in 2006—201 3 (n = 1 1), methods of extracorporeal hemocorrection were not performed. The Mann-Whitney U-test and ANOVA were used to evaluate the results.Results and discussion: the use of extracorporeal hemocorrection operations in the complex therapy of invasive forms of meningococcal infection with refractory septic shock and multiple organ failure syndrome in children provides stabilization of central hemodynamics, reduces clinical and laboratory inflammatory reactions, helps to reduce the dose of vasopressor drugs and parameters of respiratory support, and also increases patient survival rate by 82.6%.

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