Diab, Mahmoud, Lehmann, Thomas, Bothe, Wolfgang, Akhyari, Payam, Platzer, Stephanie, Wendt, Daniel, Deppe, Antje-Christin, Strauch, Justus, Hagel, Stefan ORCID: 0000-0003-2999-6131, Guenther, Albrecht, Faerber, Gloria, Sponholz, Christoph, Franz, Marcus, Scherag, Andre, Velichkov, Ilia, Silaschi, Miriam, Fassl, Jens, Hofmann, Britt, Lehmann, Sven, Schramm, Rene, Fritz, Georg, Szabo, Gabor ORCID: 0000-0001-6038-9968, Wahlers, Thorsten, Matschke, Klaus, Lichtenberg, Artur, Pletz, Mathias W., Gummert, Jan F., Beyersdorf, Friedhelm ORCID: 0000-0003-2975-2751, Hagl, Christian, Borger, Michael A., Bauer, Michael, Brunkhorst, Frank M. and Doenst, Torsten (2022). Cytokine Hemoadsorption During Cardiac Surgery Versus Standard Surgical Care for Infective Endocarditis (REMOVE): Results From a Multicenter Randomized Controlled Trial. Circulation, 145 (13). S. 959 - 969. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1524-4539

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Abstract

BACKGROUND: Cardiac surgery often represents the only treatment option in patients with infective endocarditis (IE). However, IE surgery may lead to a sudden release of inflammatory mediators, which is associated with postoperative organ dysfunction. We investigated the effect of hemoadsorption during IE surgery on postoperative organ dysfunction. METHODS: This multicenter, randomized, nonblinded, controlled trial assigned patients undergoing cardiac surgery for IE to hemoadsorption (integration of CytoSorb to cardiopulmonary bypass) or control. The primary outcome (change in sequential organ failure assessment score [Delta SOFA]) was defined as the difference between the mean total postoperative SOFA score, calculated maximally to the 9th postoperative day, and the basal SOFA score. The analysis was by modified intention to treat. A predefined intergroup comparison was performed using a linear mixed model for Delta SOFA including surgeon and baseline SOFA score as fixed effect covariates and with the surgical center as random effect. The SOFA score assesses dysfunction in 6 organ systems, each scored from 0 to 4. Higher scores indicate worsening dysfunction. Secondary outcomes were 30-day mortality, duration of mechanical ventilation, and vasopressor and renal replacement therapy. Cytokines were measured in the first 50 patients. RESULTS: Between January 17, 2018, and January 31, 2020, a total of 288 patients were randomly assigned to hemoadsorption (n=142) or control (n=146). Four patients in the hemoadsorption and 2 in the control group were excluded because they did not undergo surgery. The primary outcome, Delta SOFA, did not differ between the hemoadsorption and the control group (1.79 +/- 3.75 and 1.93 +/- 3.53, respectively; 95% CI, -1.30 to 0.83; P=0.6766). Mortality at 30 days (21% hemoadsorption versus 22% control; P=0.782), duration of mechanical ventilation, and vasopressor and renal replacement therapy did not differ between groups. Levels of interleukin-1 beta and interleukin-18 at the end of integration of hemoadsorption to cardiopulmonary bypass were significantly lower in the hemoadsorption than in the control group. CONCLUSIONS: This randomized trial failed to demonstrate a reduction in postoperative organ dysfunction through intraoperative hemoadsorption in patients undergoing cardiac surgery for IE. Although hemoadsorption reduced plasma cytokines at the end of cardiopulmonary bypass, there was no difference in any of the clinically relevant outcome measures.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Diab, MahmoudUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lehmann, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bothe, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Akhyari, PayamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Platzer, StephanieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wendt, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Deppe, Antje-ChristinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Strauch, JustusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagel, StefanUNSPECIFIEDorcid.org/0000-0003-2999-6131UNSPECIFIED
Guenther, AlbrechtUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Faerber, GloriaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sponholz, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Franz, MarcusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Scherag, AndreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Velichkov, IliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Silaschi, MiriamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fassl, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hofmann, BrittUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lehmann, SvenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schramm, ReneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fritz, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Szabo, GaborUNSPECIFIEDorcid.org/0000-0001-6038-9968UNSPECIFIED
Wahlers, ThorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Matschke, KlausUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lichtenberg, ArturUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pletz, Mathias W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gummert, Jan F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Beyersdorf, FriedhelmUNSPECIFIEDorcid.org/0000-0003-2975-2751UNSPECIFIED
Hagl, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Borger, Michael A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bauer, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Brunkhorst, Frank M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Doenst, TorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-694377
DOI: 10.1161/CIRCULATIONAHA.121.056940
Journal or Publication Title: Circulation
Volume: 145
Number: 13
Page Range: S. 959 - 969
Date: 2022
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Place of Publication: PHILADELPHIA
ISSN: 1524-4539
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
TUMOR-NECROSIS-FACTOR; SHORT-TERM SURVIVAL; CARDIOPULMONARY BYPASS; SEPSIS; ADSORPTION; HEMOFILTRATION; INTERLEUKIN-6Multiple languages
Cardiac & Cardiovascular Systems; Peripheral Vascular DiseaseMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/69437

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