Blood Purification最新文献

{"title":"Association between Cytokine Adsorption Therapy and Organ Dysfunction Trajectories in Septic Shock with AKI: A Retrospective Cohort Study.","authors":"İlhan Kılıç, Yağmur Çağlayan, Hasan Ali Kiraz, Serkan Bakırdöğen, Ersen Karakılıç","doi":"10.1159/000551454","DOIUrl":"10.1159/000551454","url":null,"abstract":"<p><strong>Introduction: </strong>Septic shock with acute kidney injury (AKI) carries a high risk of mortality and multi-organ dysfunction. Cytokine adsorption therapy has been proposed as a potential adjunct to continuous renal replacement therapy. We aimed to evaluate the association between cytokine adsorption and short-term organ dysfunction as well as in-hospital mortality in patients treated with continuous veno-venous hemodiafiltration (CVVHDF).</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 73 adult patients with septic shock and AKI who underwent CVVHDF. Patients receiving additional cytokine adsorption therapy using the HA330 cartridge were compared with those receiving standard treatment. The primary outcome was 72-h change in SOFA score (ΔSOFA). Secondary outcomes included in-hospital mortality and hemodynamic trends. Multivariable logistic regression and Cox proportional hazards models were applied to adjust for confounding and assess survival.</p><p><strong>Results: </strong>Cytokine adsorption therapy was associated with a significantly greater median ΔSOFA score (5.9 vs. 0.0; p < 0.001). In-hospital mortality was lower in the cytokine group (hazard ratio 0.46; 95% confidence interval: 0.23-0.92; p = 0.027). Logistic regression confirmed cytokine adsorption as an independent predictor of survival (OR = 0.006, p = 0.039). The model demonstrated excellent discrimination (ROC AUC = 0.930) with high sensitivity (97.7%) at the 0.5 threshold. Exploratory subgroup analyses suggested that membrane type and microbial profile may modify treatment response.</p><p><strong>Conclusion: </strong>In this retrospective cohort, cytokine adsorption therapy was independently associated with early improvements in organ dysfunction and reduced in-hospital mortality. These findings support its potential therapeutic role, but require confirmation in larger multicenter prospective trials.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"483-501"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive Care Unit versus High-Dependency Care Unit for Patients with Sepsis-Associated Acute Kidney Injury Requiring Continuous Kidney Replacement Therapy: An Observational Nationwide Database Study.","authors":"Yoshihisa Miyamoto, Hiroyuki Ohbe, Ryota Inokuchi, Kiyohide Fushimi, Kent Doi, Hideo Yasunaga","doi":"10.1159/000550916","DOIUrl":"10.1159/000550916","url":null,"abstract":"<p><p><p>Background: Sepsis is a life-threatening condition that often leads to severe acute kidney injury (AKI). Continuous kidney replacement therapy (CKRT) can be provided to critically ill patients in resource-rich settings such as intensive care units (ICUs). However, whether different medical staffing levels exert a significant effect on the outcomes of patients with sepsis-associated AKI treated with CKRT is unknown. We aimed to compare the outcomes of patients with sepsis-associated AKI who received CKRT upon admission to an ICU versus a high-dependency unit (HDU), where the staffing intensity is lower than that in ICUs.</p><p><strong>Methods: </strong>This retrospective cohort study used data retrieved from the Diagnosis Procedure Combination database and enrolled adult patients with sepsis admitted to an ICU or HDU between April 2018 and March 2023. We identified patients who initiated CKRT on admission and assigned them to the ICU or HDU group. We conducted matching weight analyses using propensity scores to compare the frequencies of in-hospital mortality and complications between the groups.</p><p><strong>Results: </strong>Of 81,934 patients with sepsis, CKRT for severe AKI was initiated in HDUs and ICUs for 1,136 and 4,622 patients, respectively. Patients in the ICU group had higher cardiovascular Sequential Organ Failure Assessment subscores, lower body mass index values, worse consciousness levels, and a greater need for mechanical ventilation compared with those in the HDU group. After adjustment, in-hospital mortality did not differ significantly between the ICU and HDU groups (-1.9 percentage points, 95% confidence interval: -5.2 to 1.4). Moreover, significant differences were not observed in complications including gastrointestinal bleeding, infections, thromboembolism, or cerebrovascular events. These findings remained consistent across the subgroup analyses.</p><p><strong>Conclusions: </strong>In this large cohort study, in-hospital mortality or other clinical outcomes did not differ significantly between patients initially treated in ICUs and HDUs. Further investigations are warranted to understand the relevant factors that guide the triage of these patients. </p>.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"287-295"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does oXiris Matter? A Comparative Outcome Study in Continuous Renal Replacement Therapy-Treated Septic Intensive Care Unit Patients.","authors":"Payam Rahimi, Furkan Tontu, Batoul Khoundabi, Nuri Burkay Soylu, Tuğba Yücel Yenice, Yasemin Çelik, Zafer Çukurova, Sinan Aşar","doi":"10.1159/000549550","DOIUrl":"10.1159/000549550","url":null,"abstract":"<p><p><p>Introduction: Sepsis and septic shock frequently lead to acute kidney injury and the need for continuous renal replacement therapy (CRRT). The oXiris hemofilter has cytokine- and endotoxin-adsorptive properties that may improve outcomes, but evidence remains inconclusive. This study compared the clinical outcomes of septic intensive care unit (ICU) patients treated with CRRT using oXiris versus standard filters.</p><p><strong>Methods: </strong>We conducted a retrospective observational study at a tertiary ICU in Istanbul between January 2019 and June 2024. Adult septic patients requiring CRRT within 24 h of ICU admission were included. Patients were treated with either oXiris or standard CRRT filters (M-100/M-150) for ≥16 h. The primary endpoint was ICU mortality; secondary endpoints included ventilator-free days (VFDs), ICU length of stay, and trends in inflammatory and biochemical markers.</p><p><strong>Results: </strong>A total of 360 patients were analyzed (133 oXiris, 227 standard filters). Despite higher baseline sequential organ failure assessment (SOFA) scores, c-reactive protein (CRP), procalcitonin (PCT), and lactate in the oXiris group, ICU survival was significantly higher (61.7% vs. 48.9%, p = 0.019). After adjustment, oXiris use remained independently associated with improved survival (odds ratio 1.68, 95% confidence interval 1.09-2.60, p = 0.020). Total CRRT duration was markedly shorter in the oXiris group (56.4 vs. 107.4 h, p < 0.001). VFDs were similar between groups. Inflammatory markers (CRP, PCT) remained elevated in oXiris patients through day 5, while hemodynamic stabilization (lactate decline, norepinephrine reduction) was more pronounced. Platelet counts decreased in both groups without recovery.</p><p><strong>Conclusion: </strong>Our study demonstrated that patients with sepsis treated using the oXiris filter exhibited significantly higher ICU survival rates, despite higher mechanical ventilation duration and ICU length of stay. However, persistent elevations in CRP and PCT, along with thrombocytopenia, suggest that these markers may not fully reflect therapeutic response. While oXiris use was associated with reduced ICU mortality, further randomized trials are needed to confirm its efficacy and account for potential confounders. </p>.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"79-90"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12714355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145538431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Expert Interpretation on the Evolution of oXiris®-Focused Consensus Statements: From Europe to the Asia-Pacific (2019-2024).","authors":"Ling Zhang, Minmin Wang","doi":"10.1159/000550150","DOIUrl":"10.1159/000550150","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"227-230"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Citrate Anticoagulation in Pediatric Patients: Dealing with Practice Points.","authors":"Zaccaria Ricci, Akash Deep, Stuart L Goldstein","doi":"10.1159/000548786","DOIUrl":"10.1159/000548786","url":null,"abstract":"<p><strong>Background: </strong>Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) has been shown to be safe and effective both in adults and children. The equipment and the solutions available in the pediatric setting are the same as in adults.</p><p><strong>Summary: </strong>Currently three commercially available citrate formulations for RCA during continuous renal replacement therapy CRRT are present: concentrated (4% trisodium citrate, 136 mmol/L), semi-concentrated (anticoagulant dextrose-A, ACD-A, 75 mmol/L) and diluted (Prismocitrate/Regiocit, 18 mmol/L). RCA is delivered as a predilution infusion solution; therefore, its volume in dedicated commercially available citrate solutions impacts continuous renal replacement (CRRT) dose, filtration fraction, circuit pressures, and fluid flow. These aspects represent crucial details in the pediatric setting, and their relevance is more important as the smaller the patient's body weight is. Thus, when RCA is prescribed in children, the blood pump flow rate, the dose, the load and the concentration of citrate, and the patient's ability to metabolize citrate should be considered carefully and specifically contextualized by the citrate concentration available in each center. This technical review will describe these practice concepts that should be known in detail by the clinician approaching RCA in the pediatric setting.</p><p><strong>Key messages: </strong>Citrate \"dose\" is the citrate concentration in the blood running in the CRRT circuit. Citrate \"load\" represents the mass of citrate that is delivered to the circuit per each treatment hour. For a given citrate dose and blood flow rate, very different CRRT settings, sodium loads, filtration fractions, and dialytic doses are delivered by choosing the different formulations.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"26-29"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous Chamber Design: A Comparative Analysis of Retention Characteristics.","authors":"Osamu Yamaga, Masafumi Fukuda, Kei Fukami, Nobuhisa Hirayu, Masakazu Nabeta, Tetsurou Imai, Gaku Sugihara, Osamu Takasu, Norio Yamashita","doi":"10.1159/000545779","DOIUrl":"10.1159/000545779","url":null,"abstract":"<p><strong>Introduction: </strong>The air trap chamber used in continuous renal replacement therapy (CRRT) often causes clot formation due to gas interface, blood stasis and turbulent flow. The designs of this chamber vary widely. Few studies have quantitatively evaluated ex vivo quasi-blood stasis for different chamber types.</p><p><strong>Methods: </strong>Flow retention characteristics at 20, 30, 40, 50, and 60 s in a top-feed chamber (where blood flow enters vertically from the top and passes through a mesh within the air trap chamber with a chamber 12 mL in volume) and a side-feed chamber (where blood flow enters from the side and bottom, without a mesh filter, with a flow deviator and 6 mL chamber volume) were evaluated using a 30% glycerin and iodine povidone-solution. Still images of the chambers at each time point were converted to 8-bit grayscale using Image J software (ver.1.54, Maryland, USA), with a brightness threshold in the range of 1-80 to compare the two chamber designs.</p><p><strong>Results: </strong>Both chambers showed a decrease in the values of the highlighted areas over time; however, from 20 s, the side-feed chamber showed significantly lower values of the highlighted areas compared with the top-feed chamber. Similar to the findings at 20 s, significant differences in the values of the highlighted areas favored the side-feed chamber and persisted at 30, 40, 50, and 60 s. Furthermore, pseudo blood remained superficially in the top-feed chamber, while the side-feed chamber exhibited vortex flow, less stasis, turbulence, and stagnation.</p><p><strong>Conclusion: </strong>The two chambers tested emptied of pseudo blood at different rates, with varying retention characteristics, with the side-feed chamber showing less pseudo-blood retention at all-time points assessed.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"239-246"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-Course Changes in Biomarker Levels Observed in Effluent of Patients Administered Bicarbonate/Lactate-Buffered Neutral-pH Peritoneal Dialysis Fluid.","authors":"Risa Terashima, Nanae Matsuo, Yudo Tanno, Yukio Maruyama, Ichiro Ohkido, Takashi Yokoo","doi":"10.1159/000550321","DOIUrl":"10.1159/000550321","url":null,"abstract":"<p><strong>Introduction: </strong>Biomarker levels in peritoneal dialysis (PD) effluent can predict the risks of inflammation, wasting, atherosclerosis, encapsulating peritoneal sclerosis, and mortality. However, assessments of biomarker variations associated with different dwell times and buffered solutions have yielded inconsistent results.</p><p><strong>Methods: </strong>This prospective crossover study examined 10 patients on PD to investigate changes in effluent biomarkers during a retention period of 8 h. Biomarker concentrations in bicarbonate lactate-buffered neutral-pH PD fluid (Bic/Lac PDF) effluent and those in lactate-buffered neutral-pH PD fluid (Lac PDF) effluent were compared.</p><p><strong>Results: </strong>Concentrations of urea nitrogen, creatinine, β2-microglobulin, and α1-microglobulin associated with Bic/Lac PDF and Lac PDF did not differ (analysis of variance [ANOVA]: p = 0.62, 0.25, 0.73, and 0.95, respectively). Differences in cancer antigen 125, interleukin-6, fibrin degradation products (FDP), vascular endothelial growth factor (VEGF), and tumor necrosis factor-α (TNF-α) were not observed (ANOVA: p = 0.81, 0.72, 0.66, 0.87, and 0.94, respectively). Additionally, concentrations of these biomarkers gradually increased over time from the start of PDF infusion until 8 h later; however, in some cases, FDP, VEGF, and TNF-α concentrations in effluent were below the detection limits at 2, 4, 6, and 8 h.</p><p><strong>Conclusion: </strong>A protective effect of Bic/Lac PDF on the peritoneal membrane was not observed. Biomarker concentrations in PD effluent gradually increased over time; however, some were below the detection limits during 8 h of retention. Assessments of biomarkers in effluent should be performed after an extended dwell time.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"315-322"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stability and Compatibility of Levofloxacin, Clindamycin Phosphate, and Fluconazole in Various Peritoneal Solutions.","authors":"Zanzhe Yu, Yiwei Shen, Yue Qian, Jiaying Huang, Yanna He, Hao Yan, Leyi Gu, Wei Fang","doi":"10.1159/000550285","DOIUrl":"10.1159/000550285","url":null,"abstract":"<p><strong>Introduction: </strong>Intraperitoneal administration of antibiotics is recommended for the treatment of peritoneal dialysis (PD)-related peritonitis. Antibiotics pre-added PD solution is commonly used for home-based treatment. Some antibiotics are recommended by ISPD for peritonitis treatment but does not have stability and compatibility data in different conditions yet. The current study was to investigate the stability and compatibility of such drugs.</p><p><strong>Methods: </strong>Levofloxacin, clindamycin phosphate, and fluconazole were tested in the study. Three different commercially available PD solutions were selected. Two were glucose-based (2.5%, Ca 1.25 mmol/L, lactate buffered) solutions, one with PVC package and the other with non-PVC package. The third solution was icodextrin (non-PVC package). The stability of the three antibiotics was tested in the three different dialysates at different temperatures (4°C and 25°C) for 6 h, 1 day, 2 days, and 7 days. At 37°C, the storage stability was tested only for 6 h. The test antibiotics concentrations were selected as ISPD recommended or based on published data. All conditions were repeated separately in three bags. The antibiotics concentrations were measured by liquid chromatography-tandem mass spectrometry.</p><p><strong>Results: </strong>For clindamycin phosphate and fluconazole, there was no significant change in final concentration over the 7 days study period at both 4°C and 25°C. At 37°C, there was also no difference in concentration for clindamycin phosphate and fluconazole. For levofloxacin, there was no significant change in concentration over 7 days at 4°C. The concentration of levofloxacin was slightly higher after storage at 25°C and 37°C, while the exact differences were less than 3%. We noticed small but significant difference in drug concentrations for different solutions. It was generally lower in icodextrin than in glucose-based solutions. The exact differences were less than 10%. The difference between icodextrin and glucose-based solutions was higher than the two glucose-based solutions with different container material (PVC vs. non-PVC).</p><p><strong>Conclusions: </strong>Levofloxacin, clindamycin phosphate, and fluconazole were stable and compatible with both glucose-based and icodextrin solutions. They might be stored for up to 7 days at room temperature (25°C). It is not suggested to store the dialysate for long time once warmed up to body temperature.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"171-177"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Long-Term Mortality in Acute Hypercapnic Respiratory Failure with Use of Low-Flow Veno-Venous Extracorporeal CO₂ Removal: A Retrospective Single-Center Study.","authors":"Anne-Aylin Sigg, Stefanie Keiser, Shalimar Mila Konopasek, Stephanie Klinzing, Pedro David Wendel-Garcia, Marco Maggiorini, Reto Andreas Schuepbach, Matthias Peter Hilty","doi":"10.1159/000550776","DOIUrl":"10.1159/000550776","url":null,"abstract":"<p><p><p>Introduction: Hypercapnic respiratory failure is associated with high morbidity and mortality. Low-flow extracorporeal CO₂ removal (ECCO₂R) has been shown to facilitate lung-protective ventilation or spontaneous breathing. However, three multicenter randomized trials have failed to show benefit which could potentially be a result of patient selection. In this study, we aimed to characterize prognostic scores developed for extracorporeal membrane oxygenation therapy which could potentially assist with the selection of patients for ECCO₂R.</p><p><strong>Methods: </strong>A total of 70 patients admitted to the intensive care unit at the University Hospital of Zurich between 10/2009 and 02/2017 with hypercapnic respiratory failure were treated with ECCO₂R if pH ≤7.25 and/or PaCO₂ ≥ 9 kPa experiencing respiratory exhaustion during spontaneous breathing in obstructive lung disease or reaching the limits of lung protective ventilation (n = 22 and n = 48) in patients with restrictive lung pathologies. Data including baseline characteristics and respiratory parameters were collected prospectively. Scores were calculated retrospectively.</p><p><strong>Results: </strong>The underlying diseases were acute respiratory distress syndrome (n = 27), chronic-obstructive pulmonary disease (n = 12), bronchiolitis obliterans syndrome (BOS; n = 9), cystic fibrosis (n = 10), pulmonary fibrosis (n = 8), and other causes (n = 4). The 180-day mortality was 45.7% with the highest rate observed in PF and BOS patients as well as in patients who had been mechanically ventilated >6 days before initiation of ECCO₂R. The modified PRedicting dEath for SEvere hypercapnic respiratory failure on vv-ECCO₂R (PRESERVE-CO₂) score differentiated well between survivors and non-survivors (4.3 ± 2.2 vs. 6.9 ± 2.6, p < 0.01), whereas the modified Respiratory ECMO Survival Prediction (RESP-CO₂) score showed no significant distinction. Receiver operating characteristics analysis of the PRESERVE-CO₂ score revealed an area under the curve of 0.78, suggesting a cut-off of 7 points.</p><p><strong>Conclusion: </strong>Careful selection of patients for ECCO₂R therapy may help to improve outcomes. The proposed PRESERVE-CO₂ score may serve as a guide. A score of 7 points or higher is associated with an unfavorable outcome regarding the 180-day mortality in the specific patient cohort of this study, but future studies to externally validate this score are required. </p>.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"255-267"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endotoxin, Virus, and Bacterial Removal: Why, When, and How?","authors":"Lui G Forni, Vedran Premuzic","doi":"10.1159/000546923","DOIUrl":"10.1159/000546923","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and where underlying circulatory, cellular, and metabolic abnormalities contribute to a greater risk of mortality than that posed by sepsis alone, this may be considered septic shock where circulatory support is needed in the face of a raised lactate level. The main pillars of therapy remain source control and appropriate timely antibiotics, resuscitation where needed, and adequate source control. However, in the setting of organ failure further support may be needed.</p><p><strong>Summary: </strong>Here, we discuss the potential benefits from removal of pathogens using available extracorporeal techniques. Although randomized controlled trials supporting such an approach remain elusive, this is due to change in the next few years with current studies being performed. The use of extracorporeal blood purification therapies is a promising therapeutic strategy for critically ill ICU patients with high pathogen load refractory to conservative treatment or with elevated endotoxin levels.</p><p><strong>Key messages: </strong>By targeting specific inflammatory mediators and pathogens, extracorporeal blood purification can help mitigate the severe inflammatory response associated with sepsis which should translate into improved patient survival. This approach may be particularly beneficial in cases where traditional treatments fail highlighting the need for further data to optimize the use of blood purification therapies in sepsis management.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"414-421"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}