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Single-centre retrospective evaluation of intraoperative hemoadsorption in left-sided acute infective endocarditis
ID Kališnik, Jurij-Matija (Author), ID Leiler, Špela (Author), ID Mamdooh, Hazem (Author), ID Žibert, Janez (Author), ID Bertsch, Thomas (Author), ID Vogt, Ferdinand (Author), ID Bagaev, Erik (Author), ID Fittkau, Matthias (Author), ID Fischlein, Theodor (Author)

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Abstract
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.

Language:English
Keywords:infective endocarditis, sepsis, hemoadsorption, CytoSorb, cytokine release syndrome
Work type:Article
Typology:1.01 - Original Scientific Article
Organization:ZF - Faculty of Health Sciences
Publication status:Published
Publication version:Version of Record
Publication date:07.07.2022
Year:2022
Number of pages:13 str.
Numbering:Vol. 11, iss. 14, art. 3954
PID:20.500.12556/RUL-138147 This link opens in a new window
UDC:616.126
ISSN on article:2077-0383
DOI:10.3390/jcm11143954 This link opens in a new window
COBISS.SI-ID:115117315 This link opens in a new window
Publication date in RUL:12.07.2022
Views:687
Downloads:113
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Record is a part of a journal

Title:Journal of clinical medicine
Shortened title:J. clin. med.
Publisher:MDPI
ISSN:2077-0383
COBISS.SI-ID:5405759 This link opens in a new window

Licences

License:CC BY 4.0, Creative Commons Attribution 4.0 International
Link:http://creativecommons.org/licenses/by/4.0/
Description:This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.
Licensing start date:07.07.2022

Secondary language

Language:Undetermined
Keywords:infekcijski endokarditis, sepsa, hemoadsorbcija, CytoSorb, sindrom sproščanja citokinov

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