Supplementary Material for: Changes in Cytokines, Haemodynamics and Microcirculation in Patients with Sepsis/Septic Shock Undergoing Continuous Renal Replacement Therapy and Blood Purification with CytoSorb

Background: Extracorporeal blood purification therapies have been proposed as a strategy to remove inflammatory mediators during sepsis, thus improving outcome. Objectives: We aimed to evaluate changes in cytokines, haemodynamics and microcirculation during blood purification with Cytosorb adsorber in septic patients. Methods: Prospective observational study on critically ill adult patients with sepsis/septic shock underwent renal replacement therapy (RRT) for acute renal failure and haemoadsorption with Cytosorb as adjunctive therapy for 24 h. Measurements were taken at baseline, after 6 and 24 h: haemodynamic parameters, arterial and central venous blood gases, plasma levels of tumour necrosis factor alpha, interleukin (IL) 1-beta, IL-6, IL-8 and IL-10. The sublingual microcirculation was assessed with sidestream dark field videomicroscopy to evaluate the perfused vessel density (PVD) and microvascular flow quality. Tissue oxygenation and microvascular reactivity were assessed with thenar near infrared spectroscopy (NIRS) with a vascular occlusion test. Results: Nine patients; plasma levels of IL-8 decreased at 24 h (p 2 respectively, p = 0.003) and total vessel densities at 24 h (14.9 [13.9–16.9] vs. 17.9 [15.3–20], p = 0.0015). No significant variation was detected in NIRS-derived parameters. The Sequential Organ Failure Assessment score decreased from 12 ± 3 to 10 ± 1 at 24 h (p = 0.039). Conclusions: In septic patients undergoing RRT, haemoadsorption with Cytosorb seems to determine a decreasing in plasma levels of IL-8, although levels of other cytokines did not vary significantly, and an improvement of microcirculation despite no significant variation in macro-haemodynamics.

背景：体外血液净化疗法已被提议作为脓毒症期间清除炎症介质、改善患者预后的治疗策略。
目的：本研究旨在评估脓毒症患者使用Cytosorb吸附器进行血液净化过程中细胞因子、血流动力学及微循环的变化情况。
方法：本研究为前瞻性观察性研究，纳入因急性肾衰竭接受肾脏替代治疗（RRT）的重症成年脓毒症/脓毒性休克患者，辅以Cytosorb血液灌流治疗24小时。分别于基线、6小时及24小时时点进行检测，检测指标包括血流动力学参数、动脉及中心静脉血气分析、肿瘤坏死因子-α、白细胞介素（IL）1-β、IL-6、IL-8及IL-10的血浆水平。采用侧流暗视野视频显微镜评估舌下微循环，以计算灌注血管密度（PVD）与微血管血流质量；通过鱼际近红外光谱（NIRS）结合血管闭塞试验评估组织氧合与微血管反应性。
结果：共纳入9例患者。24小时时IL-8血浆水平下降（相关p值分别为<0.002，p=0.003，原文疑似存在输入漏失），总血管密度于24小时时升高（14.9[13.9~16.9] vs. 17.9[15.3~20]，p=0.0015）。近红外光谱衍生参数未检测到显著变化。序贯器官衰竭评估（Sequential Organ Failure Assessment，SOFA）评分于24小时时从12±3降至10±1（p=0.039）。
结论：对于接受肾脏替代治疗的脓毒症患者，采用Cytosorb进行血液灌流可降低IL-8血浆水平，尽管其他细胞因子水平无显著变化；同时可改善微循环，尽管宏观血流动力学未出现显著变化。