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

Janina Praxenthaler; Elke Schwier; Simon Altmann; Carmen Kirchner; Julian Bialas; Dietrich Henzler; Thomas Köhler

doi:10.3390/biomedicines10102340

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

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

Authors

Janina Praxenthaler^{1

2}, Elke Schwier¹, Simon Altmann^{1

3}, Carmen Kirchner⁴, Julian Bialas⁵, Dietrich Henzler¹, Thomas Köhler^{1

6}

Affiliations

¹ Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr-University Bochum, Klinikum Herford, 32049 Herford, Germany.
² Department of Anesthesiology, Intensive Care and Pain Medicine, KSOB-Clinics, Klinikum Traunstein, 83278 Traunstein, Germany.
³ Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany.
⁴ Department of General and Visceral Surgery, Thoracic Surgery and Proctology, Ruhr University Bochum, Klinikum Herford, 32049 Herford, Germany.
⁵ Department of Data Science and Intelligent Analytics, University of Applied Science, FH Kufstein Tirol, 6330 Kufstein, Austria.
⁶ Department of Anesthesiology and Intensive Care Medicine, AMEOS-Klinikum Halberstadt, 38820 Halberstadt, Germany.

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.

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.