Female nurse conducting blood purification therapy

Blood Purification and Sepsis Management

The only therapy that can effectively remove inflammatory mediators, damage-associated molecular patterns (DAMPS) and/or pathogen-associated molecular patterns (PAMPs) (e.g., endotoxin).

Inflammatory mediators are released into the blood as part of the normal, innate immune response to an external trigger.1,2

Pathogen-associated molecular patterns (PAMPs)

All pathogens exhibit specific components on their surface, known as PAMPs (e.g., endotoxin).1

Damage-associated molecular patterns (DAMPs)

When host cells are damaged, they release endogenous molecules known as DAMPs, such as adenosine triphosphate (ATP), mitochondrial deoxyribonucleic acid (DNA) and high-mobility group box 1 (HMGB1).2,3

Inflammatory mediators, such as cytokines

Inflammatory mediators are key signalling molecules that regulate the inflammatory response, including pro- and anti-inflammatory cytokines, e.g., interleukin (IL)-6, IL-8, IL-10 and tumour necrosis factor (TNF)-α.4

A dysregulated inflammatory mediator response to PAMPs results in elevated levels of inflammatory mediators, such as pro- and anti-inflammatory cytokines, which may lead to a series of reactions resulting in cellular and tissue injury.1,4

Infection, trauma, acute disease and certain therapeutic interventions can be associated with a dysregulated inflammatory mediator response. Patients can include those with4-10:

  • Sepsis/septic shock
  • Severe COVID-19
  • Acute respiratory distress syndrome (ARDS)
  • Severe acute pancreatitis
  • Acute and acute-on-chronic liver failure
  • Chimeric antigen receptor (CAR) T-cell therapy–associated toxicity
  • Systemic inflammatory response syndrome (SIRS) due to severe burns or trauma    
Illustration showing dysregulated inflammatory mediator response leading to cellular injury

Sepsis and septic shock are associated with high rates of mortality and morbidity

Sepsis and septic shock

  • Analysis of data from the Global Burden of Diseases Study estimated the total annual number of sepsis and septic shock cases in 2017 to be 48.9 million, leading to approximately 11 million deaths; this accounted for ~20% of all deaths worldwide.11
  • Elevated plasma cytokine levels, particularly IL-6, are associated with an increased risk of mortality following ICU admission in patients with sepsis or septic shock.12-15
  • High endotoxin activity is associated with greater illness severity16-18 and organ failure in patients with sepsis/septic shock.16

Multi-organ dysfunction

  • Multi-organ failure has been reported in ~75% of critically ill patients with severe sepsis.19
  • Combined renal and respiratory failure is common in critically ill patients; ~25% of patients with severe COVID-19 receiving advanced respiratory support also require renal support.20
  • Multi-organ dysfunction/failure may be associated with an increased risk of short- and long-term mortality,21-30 contributing to as many as 50% of ICU deaths.21,22

COVID-19

  • As of May 2022, the World Health Organization (WHO) reported a total of >513 million confirmed cases of COVID-19 globally, including >6 million deaths.31
  • Inflammatory mediators, DAMPs and PAMPs, including endotoxin and SARS-CoV-2 particles, are possible contributors to multi-organ failure in critically ill COVID-19 patients.5

Benefits of blood purification therapy

Illustration showing blood purification process of removing mediators and toxins from the blood
Graph showing change from baseline in norepinephrine infusion rate during the first 24-hour treatment period with an adsorptive filter set
Chart showing change from baseline in SOFA score during first 72 hours of treatment with an adsorptive filter set
Female patient in critical care receiving blood purification therapy
Blood purification is defined as the process of removing mediators and toxins, which may cause pathogenesis, from the blood.1,32

Blood purification therapies are designed to remove inflammatory mediators, PAMPs (such as endotoxin) and/or DAMPs (such as HMGB-1) to address the effects of an unbalanced immune system.1,33

Evidence suggests that the use of blood purification therapies is associated with a decrease in norepinephrine dose/infusion rate in patients with sepsis or septic shock.34-38   

A randomised, crossover, double-blind study of patients with septic shock and AKI reported an 87% decrease in norepinephrine infusion rate from baseline after 24 hours of treatment with continuous renal replacement therapy (CRRT) and blood purification therapy using an adsorptive filter set designed to remove inflammatory mediators and endotoxin (P= 0.02).38

Evidence suggests that the use of blood purification therapies is associated with clinical improvement in organ function (as measured by SOFA score) in patients with severe COVID-19 with or without AKI.39,40

A prospective, multicenter, observational study reported an improvement in organ function, as measured by SOFA score (P = 0.002), in critically ill patients with severe COVID-19 treated with blood purification therapy using an adsorptive filter set removing inflammatory mediators and endotoxin (a PAMP), as well as lower observed mortality vs. predicted mortality as measured by APACHE IV score.39,40

Blood purification has the potential to help mitigate multi-organ failure and improve outcomes.34-42

Blood purification is the only therapy that can effectively remove inflammatory mediators, DAMPS and/or PAMPs (e.g., endotoxin),1 which may help mitigate multi-organ failure and improve patient outcomes.34-42

Blood purification therapy for COVID-19

The connection between COVID-19 and sepsis

In this editorial, Jean-Louis Vincent, MD, PhD, Professor of Intensive Care Medicine at l’Université libre de Bruxelles, discusses how COVID-19 is a dysregulated host response to infection.43

Read article
COVID-19 can affect a number of organs and tissues44
  • Brain: strokes, seizures, mental confusion and brain inflammation
  • Eyes and nose: loss of smell and conjunctivitis
  • Lungs: alveoli cell wall destruction, diminishing oxygen uptake; coughing, fever and dyspnea
  • Heart and blood vessels: blood clots, myocardial infarction and cardiac inflammation
  • Liver: abnormal enzyme levels
  • Kidneys: kidney damage that may result from direct viral infection of the kidneys or septic shock
  • Intestines: : ≥20% of patients having diarrhoea

Related products

Vantive, Oxiris, Prismaflex and PrisMax are trademarks of Vantive Health LLC or its affiliates.

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