Outcomes of Extracorporeal Filtration In Sepsis – A Retrospective Analysis Over 2 Years

INTRODUCTION: Sepsis is one of the leading causes of mortality both globally and in India. Recent strategies aiming at restoring the immune balance by reducing and or deactivating inflammatory mediators have also been applied.(1,2). It is based on the ‘cytokine peak concentration’ hypothesis, which hypothesizes that eliminating the cytokine surge in the early stage of sepsis can limit the inflammatory cascade, thus reducing organ damage and decreasing multi organ failure.(3) The various methods of removal include high volume haemofiltration, CytoSorb hemoadsorption cartridge, coupled plasma filtration adsorption, Hemofeel filter and oXiris, which also removes endotoxins[1]. This study aims at assessing the clinical profile and outcome of septic patients who were put on extracorporeal filters in our hospital, which is a multi-speciality tertiary care centre in Kochi, Kerala. OBJECTIVES: Primary objective was to study the clinical profile and 28 day mortality of septic patients in a tertiary care hospital in whom extracorporeal filters were used. Secondary outcome was to identify the various sources of sepsis leading to a hyperinflammatory state requiring extracorporeal filters and identify risk factors leading to a poor outcome. MATERIALS AND METHODS: Retrospective observational study in which all patients with sepsis in whom extracorporeal filters were used from 1st Nov 2022 to 1st Nov 2024 were included and their clinical profile and outcome were studied from hospital and case records. Risk factors and co-morbidities leading to septic shock with hyperinflammatory states requiring extracorporeal filters were identified. RESULTS: 78 sepsis patients had been put on extracorporeal filters in our centre. The average SOFA score of the patients was 11. Patients had multiple co-morbidities, the most common being Chronic Liver Disease(30.7%). The most common source of infection was lung(32%) followed by urinary tract(19.2%). Of the total number, 65 died(84.4%) and 1 patient could not be followed up. No organism was isolated from 21 patients(26.9%) despite symptoms and laboratory evidence of septic shock with multi organ failure while 45 patients[57.6%] had gram negative isolates. The incidence of secondary infection after using extracorporeal filters was 21.7%. All patients who survived had extracorporeal filters initiated within 72 hours of ICU admission. DISCUSSION: The 28 day mortality of patients in our study was 84.4% after the use of extracorporeal filters in sepsis. However the average SOFA score of the patients was 11, which has been found to have a mortality above 95.2%(4) and 90%(5) respectively in large multi-centric trials. Use of extracorporeal therapies in sepsis have demonstrated mortality benefit in few studies(6,7) though high quality RCTs do not exist. Our study also demonstrated that early initiation played a key role in survival. CONCLUSION: Extracorporeal therapies can be tried as a salvage therapy in sepsis with hyperinflammatory states and multi organ failure. Though mortality benefits have been demonstrated in certain meta analyses, further high quality RCTs are required to support their routine use. KEYWORDS: Extracorporeal filters, Sepsis, OXiris.