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. 2022 Sep 20;10(10):2340.
doi: 10.3390/biomedicines10102340.

Immunomodulation by Hemoadsorption-Changes in Hepatic Biotransformation Capacity in Sepsis and Septic Shock: A Prospective Study

Janina Praxenthaler  1   2 , Elke Schwier  1 , Simon Altmann  1   3 , Carmen Kirchner  4 , Julian Bialas  5 , Dietrich Henzler  1 , Thomas Köhler  1   6
Affiliations

Immunomodulation by Hemoadsorption-Changes in Hepatic Biotransformation Capacity in Sepsis and Septic Shock: A Prospective Study

Janina Praxenthaler et al. Biomedicines. .

Abstract

Background: Sepsis is often associated with liver dysfunction, which is an indicator of poor outcomes. Specific diagnostic tools that detect hepatic dysfunction in its early stages are scarce. So far, the immune modulatory effects of hemoadsorption with CytoSorb® on liver function are unclear.

Method: We assessed the hepatic function by using the dynamic LiMAx® test and biochemical parameters in 21 patients with sepsis or septic shock receiving CytoSorb® in a prospective, observational study. Points of measurement: T1: diagnosis of sepsis or septic shock; T2 and T3: 24 h and 48 h after the start of CytoSorb®; T4: 24 h after termination of CytoSorb®.

Results: The hepatic biotransformation capacity measured by LiMAx® was severely impaired in up to 95 % of patients. Despite a rapid shock reversal under CytoSorb®, a significant improvement in LiMAx® values appeared from T3 to T4. This decline and recovery of liver function were not reflected by common parameters of hepatic metabolism that remained mostly within the normal range.

Conclusions: Hepatic dysfunction can effectively and safely be diagnosed with LiMAx® in ventilated ICU patients under CytoSorb®. Various static liver parameters are of limited use since they do not adequately reflect hepatic dysfunction and impaired hepatic metabolism.

Keywords: CytoSorb®; Interleukin-6; LiMAx®; dynamic liver function test; hemoadsorption; hepatic dysfunction; sepsis; sepsis-associated liver dysfunction; septic shock; static liver parameters.

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Conflict of interest statement

TK had received lecture fees from Cytosorbent Europe. The Department of Anesthesiology at Klinikum Herford received an unrestricted research grant from Cytosorbent Europe in 2018. The authors declare that they have no other competing interests.

Figures

Figure 1
Figure 1
CONSORT statement.
Figure 2
Figure 2
LiMAx®: sepsis vs. septic shock and the progression in the subgroups. LiMAx®: grey rectangle: p-values of septic shock vs. sepsis; dark blue rectangle: p-values of the subgroup sepsis (S); light blue rectangle: p-values of the subgroup septic shock (SSH); *: statistically significant. Box-whisker plot: bold lines: medians; box plots: 25th to 75th percentiles; box-whisker plots: illustrate median value with interquartile range; outliers are shown as separate points.
Figure 3
Figure 3
IL-6: sepsis vs. septic shock and the progression in the subgroups. IL-6: LiMAx®: grey rectangle: p-values of septic shock vs. sepsis; dark blue rectangle: p-values of the subgroup sepsis (S); light blue rectangle: p-values of the subgroup septic shock (SSH); *: statistically significant. Box-whisker plot: bold lines: medians; box plots: 25th to 75th percentiles; box-whisker plots: illustrate median value with interquartile range; outliers are shown as separate points.
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Grants and funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The study was partially funded (consumables) by intramural funds from the Faculty of Medicine, Ruhr-University Bochum.

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