Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8157
Peer-review started: May 1, 2021
First decision: June 15, 2021
Revised: July 26, 2021
Accepted: August 16, 2021
Article in press: August 16, 2021
Published online: September 26, 2021
Septic shock leads to multiple organ failure, and bacterial endotoxins and endogenous cytokines play essential roles in the pathogenesis. The oXiris® hemofilter can efficiently adsorb endotoxins and cytokines.
We admitted a critically ill 59 year-old male patient with gastrointestinal septic shock due to infection by a Gram-negative bacterium and septic acute kidney injury (AKI). Prior to intensive care unit admission, the patient reported intermittent diarrhea and decreased urine output. His blood pressure was 70/40 mmHg, necessitating fluid resuscitation and large doses of noradrenaline. Based on the results of a blood culture and the presence of hypotension, oliguria, and hypoxemia, we diagnosed septic shock, AKI, and multiple organ dysfunction. We administered continuous renal replacement therapy (CRRT) with an oXiris® hemofilter for 72 h with intermittent continuous veno-venous hemodiafiltration (CVVHDF), and changed the filter every 12 h. After his hemodynamic parameters were stable, we used a traditional filter (AN69 hemofilter) with intermittent CVVHDF. The 72 h CRRT with the oXiris® hemofilter led to stabilization of his vital signs, marked reductions in disease severity scores, and decreased levels of procalcitonin, endotoxin, and inflammatory factors. After 8 d of CRRT, his kidney function had completely recovered.
We conclude that the oXiris® hemofilter combined with appropriate antibacterial therapy was an effective treatment for this patient with gastrointestinal septic shock.
Core Tip: Septic shock results in multiple organ failure and is associated with a high mortality rate, and patients with septic acute kidney injury (AKI) have an even greater risk of mortality. We report the successful treatment of a patient with gastrointestinal septic AKI using continuous renal replacement therapy (CRRT) with an oXiris® hemofilter. These results suggest that early use of the oXiris® hemofilter with CCRT may be useful for other patients with gastrointestinal septic AKI.