20.500.12556/RUL-138147 Single-centre retrospective evaluation of intraoperative hemoadsorption in left-sided acute infective endocarditis Background: Cardiac surgery in patients with infective endocarditis (IE) is still associated with high mortality and morbidity; an already present inflammation might further be aggravated due to a cardiopulmonary bypass-induced dysregulated immune response. Intraoperative hemoadsorption therapy may attenuate this septic response. Our objective was therefore to assess the efficacy of intraoperative hemoadsorption in active left-sided native- and prosthetic infective endocarditis. Methods: Consecutive high-risk patients with active left-sided infective endocarditis were enrolled between January 2015 and April 2021. Patients with intraoperative hemoadsorption (Cytosorbents, Princeton, NJ, USA) were compared to patients without hemoadsorption (control). Endpoints were the incidence of postoperative sepsis, sepsis-associated death and in-hospital mortality. Predictors for sepsis-associated mortality and in-hospital mortality were analysed by multivariable logistic regression. Results: A total of 202 patients were included, 135 with active left-sided native and 67 with prosthetic valve infective endocarditis. Ninety-nine patients received intraoperative hemoadsorption and 103 patients did not. Ninety-nine propensity-matched pairs were selected for final analyses. Postoperative sepsis and sepsis-related mortality was reduced in the hemoadsorption group (22.2% vs. 39.4%, p = 0.014 and 8.1% vs. 22.2%, p = 0.01, respectively). In-hospital mortality tended to be lower in the hemoadsorption group (14.1% vs. 26.3%, p = 0.052). Key predictors for sepsis-associated mortality and in-hospital mortality were preoperative inotropic support, lactate-levels 24 h after surgery, C-reactive protein levels on postoperative day 1, chest tube output, cumulative inotropes and white blood cell counts on postoperative day 2, and new onset of dialysis. Multivariate regression analysis revealed intraoperative hemoadsorption to be associated with lower sepsis-associated (OR 0.09, 95% CI 0.013–0.62, p = 0.014) as well as in-hospital mortality (OR 0.069, 95% CI 0.006–0.795, p = 0.032). Conclusions: Intraoperative hemoadsorption holds promise to reduce sepsis and sepsis-associated mortality after cardiac surgery for active left-sided native and prosthetic valve infective endocarditis. infective endocarditis sepsis hemoadsorption CytoSorb cytokine release syndrome infekcijski endokarditis sepsa hemoadsorbcija CytoSorb sindrom sproščanja citokinov true false true Angleški jezik Ni določen Članek v reviji 2022-07-12 14:18:04 2022-07-12 14:18:05 2022-09-15 04:16:23 0000-00-00 00:00:00 2022 0 0 13 str. iss. 14, art. 3954 Vol. 11 2022 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 2022-07-07 616.126 2077-0383 10.3390/jcm11143954 115117315 Kalisnik-2022-Single-centre-retrospective-evaluat.pdf Kalisnik-2022-Single-centre-retrospective-evaluat.pdf 1 81FAFB3F027066EA1557FF280F7BA4CB 5f86c8b9bce1b5bc307938333a489553397b41ea2fb93eb4562a31421be4228a dad43d4b-01dc-11ed-8aca-00155dcfd717 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=158387 https://www.mdpi.com/2077-0383/11/14/3954 1 74a09fa5-01dc-11ed-8aca-00155dcfd717 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=158386 Zdravstvena fakulteta 0 0 0