In patients with infective endocarditis (IE), cardiac surgery was frequently the only therapy choice. However, IE surgery caused a spike in inflammatory mediators, which has been linked to organ dysfunction after surgery. Therefore, the impact of hemoadsorption during IE surgery on postoperative organ dysfunction was examined. Patients having cardiac surgery for IE were randomly allocated to hemoadsorption (the integration of CytoSorb to cardiopulmonary bypass) or control in the multicenter, randomized, nonblinded, controlled experiment. The main outcome (change in sequential organ failure assessment score [ΔSOFA]) was defined as the difference between the mean total postoperative SOFA score and the baseline SOFA score, measured up to the 9th postoperative day. The study was conducted with a modified intention to treat the approach. A linear mixed model for ΔSOFA was used to do a predetermined intergroup comparison, with the surgeon and baseline SOFA score as fixed effect variables and the surgical center as a random effect. The SOFA score rates organ system dysfunction from 0 to 4 on a scale of 0 to 4. Higher ratings imply that the dysfunction is becoming worse. 30-day mortality, mechanical breathing time, and vasopressor and renal replacement treatment were secondary outcomes. The first 50 patients had their cytokines measured.
A total of 288 patients were randomly allocated to hemoadsorption (n=142) or control (n=146) between January 17, 2018, and January 31, 2020. Because they did not have surgery, four patients in the hemoadsorption group and two in the control group were eliminated. The major outcome, ΔSOFA, did not change between the hemoadsorption and control groups (1.79±3.75, respectively; 95% CI, –1.30 to 0.83; P=0.6766). The duration of mechanical breathing and vasopressor and renal replacement treatment did not differ between groups at 30 days (21% hemoadsorption versus 22% control; P=0.782). interleukin-1β and interleukin-18 levels were considerably lower in the hemoadsorption group than in the control group at the conclusion of the integration of hemoadsorption to cardiopulmonary bypass. In patients having cardiac surgery for IE, the randomized study failed to show that intraoperative hemoadsorption reduced postoperative organ dysfunction. Despite the fact that hemoadsorption lowered plasma cytokines at the conclusion of cardiopulmonary bypass, none of the clinically important outcome markers changed.
Reference:www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.121.056940
