Coupled-plasma filtration and adsorption for severe burn patients with septic shock and acute kidney injury treated with renal replacement therapy.
BACKGROUND
Coupled-plasma filtration adsorption (CPFA) is a sorbent-based technology aimed at removing soluble mediators of septic shock. We present our experience on the use of CPFA in septic shock severe burn patients with acute kidney injury (AKI) needing renal replacement therapy (RRT) with the main goal to evaluate efficacy and safety of CPFA in this specific subset of septic shock patients.


METHODS
In this observational study, we retrospectively reviewed the medical notes of all burn patients admitted to our adult Burn Center who received CPFA, as part of the septic shock treatment requiring RRT, between January 2001 and December 2017 (CPFA group). We compared CPFA group with all the burn patients admitted to our Center in the same period of time, with the same range of relevant clinical characteristics, who developed AKI and were treated with RRT, but not CPFA (control group). We collected demographic characteristics, burn size, Sequential Organ Assessment Failure (SOFA) score, microbiological data, and patient outcome, in terms of in-hospital mortality rate and the probability of survival calculated using the revised Baux score. We also collected data regarding CPFA safety (hemorrhagic episodes, catheter associated-complications, hypersensitivity reactions) and efficiency (number and duration of CPFA sessions, plasma treated amount, plasma processed dose).


RESULTS
39 severe burn patients were treated with CPFA (CPFA group) (mean age 46.0 years, range 40.0-56.0 years; mean burn size 48.0% TBSA, range 35.0-60.0% TBSA), and 87 patients treated with RRT, but not CPFA, who had similar clinical characteristics (control group). Observed mortality rate was 51.3% in the CPFA group and 77.1% in the control group (p 0.004). Regarding factors affecting survival in the CPFA group, SOFA score on the 1st day of CPFA resulted significant (OR 2.016, 95% CI, 1.221-3.326; p < 0.004) in the multivariate analysis logistic model.


CONCLUSIONS
CPFA treatment for burn patients with AKI-RRT and septic shock, sustained by bacterial strains non or poorly responsive to therapy, was associated with a lower mortality rate, compared to RRT alone. However, further research, such as large prospective studies, is required to clarify the role of CPFA in the treatment of burns with septic shock and AKI-RRT.
['Mariano|Filippo|F|', "Hollo'|Zsuzsanna|Z|", 'Depetris|Nadia|N|', 'Malvasio|Valeria|V|', 'Mella|Alberto|A|', 'Bergamo|Daniela|D|', 'Pensa|Anna|A|', 'Berardino|Maurizio|M|', 'Stella|Maurizio|M|', 'Biancone|Luigi|L|']
D058186:Acute Kidney Injury D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000925:Anticoagulants D002056:Burns D016022:Case-Control Studies D019343:Citric Acid D000079664:Continuous Renal Replacement Therapy D005260:Female D006493:Heparin D017052:Hospital Mortality D006801:Humans D008297:Male D008875:Middle Aged D063305:Organ Dysfunction Scores D010956:Plasmapheresis D017582:Renal Replacement Therapy D012772:Shock, Septic D055815:Young Adult
Burns Septic shock Acute kidney injury Coupled-plasma filtration adsorption