细胞因子吸附剂 Cytosorb® 对严重横纹肌溶解症患者肌红蛋白的吸附和饱和动力学:一项前瞻性试验。

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Helen Graf, Caroline Gräfe, Mathias Bruegel, Michael Zoller, Nils Maciuga, Sandra Frank, Lorenz Weidhase, Michael Paal, Christina Scharf
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引用次数: 0

摘要

背景:横纹肌溶解症是一种严重的疾病,可导致急性肾损伤,需要进行肾脏替代治疗(RRT)。细胞因子吸附剂 Cytosorb® (CS) 可用于体外清除横纹肌溶解症患者体内的肌红蛋白。然而,有关吸附能力和饱和动力学的数据仍然缺失:前瞻性 Cyto-SOLVE 研究(NCT04913298)纳入了 20 名重症监护病房的重症横纹肌溶解症患者(血浆肌红蛋白大于 5000 ng/ml)、急性肾损伤导致的 RRT 患者以及使用 CS 清除肌红蛋白的患者。在规定的时间点(开始后 10 分钟、1 小时、3 小时、6 小时和 12 小时)测量患者血液中的肌红蛋白和肌酸激酶 (CK),以及 CS 前和 CS 后的肌红蛋白和肌酸激酶 (CK)。我们用以下方法计算相对变化率(RC,%):[公式:见正文]。肌红蛋白血浆清除率(毫升/分钟)的计算方法如下:[结果:安装 CS 6 小时后,肌红蛋白血浆浓度显著下降(中位数(IQR)56,894 纳克/毫升(11,544;102,737 纳克/毫升)vs 40,125 纳克/毫升(7879;75,638 纳克/毫升)(p 结论:Cytosorb®吸附剂对肌红蛋白血浆清除率有显著影响:Cytosorb® 吸附剂能有效消除肌红蛋白。然而,吸附能力在大约三小时后迅速下降,导致效果降低。严重横纹肌溶解症患者及早更换吸附器可能会提高疗效。临床益处应在进一步的临床试验中进行研究:试验注册:ClinicalTrials.gov NCT04913298。注册日期:2021年5月7日,https//clinicaltrials.gov/study/NCT04913298。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Myoglobin adsorption and saturation kinetics of the cytokine adsorber Cytosorb® in patients with severe rhabdomyolysis: a prospective trial.

Myoglobin adsorption and saturation kinetics of the cytokine adsorber Cytosorb® in patients with severe rhabdomyolysis: a prospective trial.

Background: Rhabdomyolysis is a serious condition that can lead to acute kidney injury with the need of renal replacement therapy (RRT). The cytokine adsorber Cytosorb® (CS) can be used for extracorporeal myoglobin elimination in patients with rhabdomyolysis. However, data on adsorption capacity and saturation kinetics are still missing.

Methods: The prospective Cyto-SOLVE study (NCT04913298) included 20 intensive care unit patients with severe rhabdomyolysis (plasma myoglobin > 5000 ng/ml), RRT due to acute kidney injury and the use of CS for myoglobin elimination. Myoglobin and creatine kinase (CK) were measured in the patient´s blood and pre- and post-CS at defined time points (ten minutes, one, three, six, and twelve hours after initiation). We calculated Relative Change (RC, %) with: [Formula: see text]. Myoglobin plasma clearances (ml/min) were calculated with: [Formula: see text] RESULTS: There was a significant decrease of the myoglobin plasma concentration six hours after installation of CS (median (IQR) 56,894 ng/ml (11,544; 102,737 ng/ml) vs. 40,125 ng/ml (7879; 75,638 ng/ml) (p < 0.001). No significant change was observed after twelve hours. Significant extracorporeal adsorption of myoglobin can be seen at all time points (p < 0.05) (ten minutes, one, three, six, and twelve hours after initiation). The median (IQR) RC of myoglobin at the above-mentioned time points was - 79.2% (-85.1; -47.1%), -34.7% (-42.7;-18.4%), -16.1% (-22.1; -9.4%), -8.3% (-7.5; -1.3%), and - 3.9% (-3.9; -1.3%), respectively. The median myoglobin plasma clearance ten minutes after starting CS treatment was 64.0 ml/min (58.6; 73.5 ml/min), decreasing rapidly to 29.1 ml/min (26.5; 36.1 ml/min), 16.1 ml/min (11.9; 22.5 ml/min), 7.9 ml/min (5.5; 12.5 ml/min), and 3.7 ml/min (2.4; 6.4 ml/min) after one, three, six, and twelve hours, respectively.

Conclusion: The Cytosorb® adsorber effectively eliminates myoglobin. However, the adsorption capacity decreased rapidly after about three hours, resulting in reduced effectiveness. Early change of the adsorber in patients with severe rhabdomyolysis might increase the efficacy. The clinical benefit should be investigated in further clinical trials.

Trial registration: ClinicalTrials.gov NCT04913298. Registered 07 May 2021, https//clinicaltrials.gov/study/NCT04913298.

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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