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

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Izvleček
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.

Jezik:Angleški jezik
Ključne besede:infective endocarditis, sepsis, hemoadsorption, CytoSorb, cytokine release syndrome
Vrsta gradiva:Članek v reviji
Tipologija:1.01 - Izvirni znanstveni članek
Organizacija:ZF - Zdravstvena fakulteta
Status publikacije:Objavljeno
Različica publikacije:Objavljena publikacija
Datum objave:07.07.2022
Leto izida:2022
Št. strani:13 str.
Številčenje:Vol. 11, iss. 14, art. 3954
PID:20.500.12556/RUL-138147 Povezava se odpre v novem oknu
UDK:616.126
ISSN pri članku:2077-0383
DOI:10.3390/jcm11143954 Povezava se odpre v novem oknu
COBISS.SI-ID:115117315 Povezava se odpre v novem oknu
Datum objave v RUL:12.07.2022
Število ogledov:355
Število prenosov:68
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Gradivo je del revije

Naslov:Journal of clinical medicine
Skrajšan naslov:J. clin. med.
Založnik:MDPI
ISSN:2077-0383
COBISS.SI-ID:5405759 Povezava se odpre v novem oknu

Licence

Licenca:CC BY 4.0, Creative Commons Priznanje avtorstva 4.0 Mednarodna
Povezava:http://creativecommons.org/licenses/by/4.0/deed.sl
Opis:To je standardna licenca Creative Commons, ki daje uporabnikom največ možnosti za nadaljnjo uporabo dela, pri čemer morajo navesti avtorja.
Začetek licenciranja:07.07.2022

Sekundarni jezik

Jezik:Ni določen
Ključne besede:infekcijski endokarditis, sepsa, hemoadsorbcija, CytoSorb, sindrom sproščanja citokinov

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