The use of lipoprotein apheresis for the treatment of high-risk patients with elevated lipoprotein(a) and hypercholesterolemia

Aim: To assess the safety and efficiency of H.E.L.P.-apheresis and cascade lipid-filtration in the treatment of severe lipid disorders in high-risk patients.Methods: From 2016 to 2018 we observed 6 patients hyperLDLemia and high Lp(a)emia (> 60 mg/dL). The first group with H.E.L.P.-apheresis (n = 74 sessions) included 3 patients who underwent revascularization (coronary, femoral arteries). In the second group with cascade lipid-filtration (n = 92 sessions) - one patients underwent revascularization, two patients received drug therapy. Despite the lipid-lowering conventional therapy, no targeted low density lipoprotein (LDL) was obtained.Results: The patients of the 1st group had threefold decrease of LDL, in patients of the 2nd group LDL decreased by 68%. At the same time, in both groups, we noted a decrease in Lp(a) after the procedure by 65%-68%. Despite a decrease in high density lipoprotein (by 22%-29%) after lipid apheresis procedures, there was a positive trend in apoB100/apoA index (a decrease of 33% after HELP-apheresis procedures and 60% after cascade lipid-filtration) and a decrease in atherogenic index (38% and 53%, respectively). The changes in hematological and haemostatic parameters remained within physiological intervals.Conclusion: We noticed the successful application of lipid apheresis in patients with multifocal atherosclerosis and its complications

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Extracorporeal blood purification is becoming increasingly important in intensive therapy for multiple organ dysfunction syndrome (MODS) and sepsis, considering all of their pathophysiological aspects. The results of treatment, particularly in children, considering their anatomical and physiological features, are related to the severity and progression of organ failure, the indications that are found, the choice of method, and the timely initiation of blood purification. Multiple organ support therapy is the aim of introducing and applying blood purification today. Various extracorporeal blood purification techniques directly affect the molecular and electrolyte composition of blood and influence all structures of the human body, which can allow us to correct, recover, replace and maintain homeostasis in MODS. The potential of new extracorporeal molecular technologies allows their successful use in severe cardiac and respiratory failure, acute kidney injury and hepatic dysfunction and in complex therapy for severe infections and sepsis and extreme metabolic violations. Adult and pediatric patients after cardiac surgery with cardiopulmonary bypass form a special cohort that often requires the application of various intra- and extracorporeal techniques due to the development of MODS, infections and sepsis in the postoperative period

The Level of Oxidative Neutrophil Response When Determining Endotoxin Activity Assay: A New Biomarker for Defining the Indications and Effectiveness of Intensive Care in Patients with Sepsis

Background. To analyse the clinical informativity of the neutrophil oxidative response level (“Response”) during an Endotoxin Activity Assay (EAA) as a new biomarker defining the indications and effectiveness of intensive care in cardiac surgical patients with septic complications. Methods. Blood samples were taken from 198 adult patients who were admitted to the ICU after cardiac surgery (SIRS: 34, MODS: 36, and sepsis: 128). The composite of laboratory studies included CRP, PCT, EAA with “Response” level, and presepsin. Results. 83% of patients had a “normal” neutrophil response, 12% of patients had a low neutrophil response, and 5% of patients had a critically low neutrophil response. Patients with critically low responses had the lowest values of the EAA and the highest concentrations of PSP and D-dimer (p 0.5 has a negative predictive value; the EAA < 0.6 at “Response” < 0.5 may indicate a high level of endotoxaemia

Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial

Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) &lt; 60&nbsp;ml/min/1.73&nbsp;m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72&nbsp;h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. Results: We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7&nbsp;days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7&nbsp;days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P &lt; 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P &lt; 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21-3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion: One in ten major surgery patients developed AKD beyond 7&nbsp;days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (&gt; 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72&nbsp;h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide