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2. Extracorporeal cytokine adsorption: Significant reduction of catecholamine requirement in patients with AKI and septic shock after cardiac surgery

Author

Boss, Kristina, Jahn, Michael, Wendt, Daniel, Haidari, Zaki, Demircioglu, Ender, Thielmann, Matthias Klaus, Ruhparwar, Arjang, Kribben, Andreas, and Tyczynski, Bartosz

Subjects
Male, Physiology, Cardiovascular Procedures, Medizin, Cancer Treatment, Physical Chemistry, Biochemistry, Catecholamines, Medizinische Fakultät » Universitätsklinikum Essen » Klinik für Nephrologie, Immune Physiology, Medicine and Health Sciences, Amines, Aged, 80 and over, Innate Immune System, Cardiopulmonary Bypass, Organic Compounds, Neurochemistry, Neurotransmitters, Acute Kidney Injury, Middle Aged, Shock, Septic, Chemistry, Oncology, Physical Sciences, Cytokines, Sorption, Medicine, Female, Research Article, Adult, Biogenic Amines, Cardiac Surgery, Continuous Renal Replacement Therapy, Epinephrine, Death Rates, Science, Immunology, Surgical and Invasive Medical Procedures, Cytokine Therapy, Signs and Symptoms, Population Metrics, Renal Dialysis, Sepsis, Humans, ddc:610, Cardiac Surgical Procedures, Aged, Retrospective Studies, Population Biology, Organic Chemistry, Medizinische Fakultät » Universitätsklinikum Essen » Klinik für Thorax- und Kardiovaskuläre Chirurgie, Chemical Compounds, Biology and Life Sciences, Molecular Development, Hormones, Immune System, Adsorption, Clinical Medicine, Developmental Biology, Neuroscience
Abstract

BackgroundExtracorporeal cytokine adsorption is an option in septic shock as an additional measure to treat a pathological immune response. Purpose of this study was to investigate the effects of extracorporeal cytokine adsorption on hemodynamic parameters in patients with acute kidney injury (AKI) on continuous renal replacement therapy (CRRT) and septic shock after cardiac surgery.MethodsIn this retrospective study, a total of 98 patients were evaluated. Hemoadsorption was performed by the CytoSorb® adsorber. In all patients cytokine adsorption was applied for at least 15 hours and at least one adsorber was used per patient. To compare cumulative inotrope need in order to maintain a mean arterial pressure (MAP) of ≥ 65 mmHg, we applied vasoactive score (VAS) for each patient before and after cytokine adsorption. A paired t-test has been performed to determine statistical significance.ResultsBefore cytokine adsorption the mean VAS was 56.7 points. This was statistically significant decreased after cytokine adsorption (27.7 points, p< 0.0001). Before cytokine adsorption, the mean noradrenalin dose to reach a MAP of ≥ 65 mmHg was 0.49 μg/kg bw/min, the mean adrenalin dose was 0.12 μg/kg bw/min. After cytokine adsorption, significantly reduced catecholamine doses were necessary to maintain a MAP of ≥ 65 mmHg (0.24 μg/kg bw/min noradrenalin; p< 0.0001 and 0.07 μg/kg bw/min adrenalin; p < 0.0001). Moreover, there was a significant reduction of serum lactate levels after treatment (p< 0.0001). The mean SOFA-score for these patients with septic shock and AKI before cytokine adsorption was 16.7 points, the mean APACHE II-score was 30.2 points. The mean predicted in-hospital mortality rate based on this SOFA-score of 16.7 points was 77,0%, respectively 73,0% on APACHE II-score, while the all-cause in-hospital mortality rate of the patients in this study was 59.2%.ConclusionIn patients with septic shock and AKI undergoing cardiac surgery, extracorporeal cytokine adsorption could significantly lower the need for postoperative inotropes. Additionally, observed versus SOFA- and APACHE II-score predicted in-hospital mortality rate was decreased.

Published
2021

7. Demographic and health related data of users of a mobile application to support drug adherence is associated with usage duration and intensity

Author

Becker, Stefan, Brandl, Christopher, Meister, Sven, Nagel, Eckhard, Miron-Shatz, Talya, Mitchell, Anna, Kribben, Andreas, Albrecht, Urs-Vito, Mertens, Alexander, and Publica

Subjects
Adult, Aged, 80 and over, Male, lcsh:R, Medizin, lcsh:Medicine, Middle Aged, Mobile Applications, Medication Adherence, Young Adult, Medizinische Fakultät, Medizinische Fakultät » Universitätsklinikum Essen » Klinik für Nephrologie, Humans, ddc:61, Female, lcsh:Q, ddc:500, ddc:610, lcsh:Science, Aged, Research Article
Abstract

PLoS one 10(1), e0116980 (2015). doi:10.1371/journal.pone.0116980, Published by PLoS, Lawrence, Kan.

Published
2015
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9. Renal Transplant Recipients Treated with Calcineurin-Inhibitors Lack Circulating Immature Transitional CD19+CD24hiCD38hi Regulatory B-Lymphocytes

Author

Tebbe, Bastian, primary, Wilde, Benjamin, additional, Ye, Zeng, additional, Wang, Junyu, additional, Wang, Xinning, additional, Jian, Fu, additional, Dolff, Sebastian, additional, Schedlowski, Manfred, additional, Hoyer, Peter F., additional, Kribben, Andreas, additional, Witzke, Oliver, additional, and Hoerning, André, additional

Published
2016
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13. Renal Transplant Recipients Treated with Calcineurin-Inhibitors Lack Circulating Immature Transitional CD19+CD24hiCD38hi Regulatory B-Lymphocytes.

Author

Tebbe, Bastian, Wilde, Benjamin, Ye, Zeng, Wang, Junyu, Wang, Xinning, Jian, Fu, Dolff, Sebastian, Schedlowski, Manfred, Hoyer, Peter F., Kribben, Andreas, Witzke, Oliver, and Hoerning, André

Subjects
KIDNEY transplantation, B cells, CD antigens, CALCINEURIN, ALLOIMMUNITY, CYCLOSPORINE
Abstract

Background: CD19+CD24hiCD38hi transitional immature B-lymphocytes have been demonstrated to play an important role in regulating the alloimmune response in transplant recipients. Here, we analyzed the effect of calcineurin inhibition on these peripherally circulating regulatory B-cells (Breg) in renal transplant recipients receiving cyclosporine A (CsA) or tacrolimus. Methods: PBMCs from healthy subjects (HS) (n = 16) and renal transplant recipients (n = 46) were isolated. Flow cytometry was performed for CD19, CD24, CD38 and IL-10 either after isolation or after 72 hours of co-culture in presence of PMA/Ionomycin and TLR9-ligand in presence or absence of increasing concentrations of tacrolimus or CsA. Results: The amount of CD19+ B-cells among lymphocytes was ∼9.1% in HS, ∼3.6% in CsA (n = 11, p<0.05) and ∼6.4% in TAC (n = 35, p<0.05) treated patients. Among B-cells, a distinct subset of Breg was found to be 4.7% in HS, 1.4% in tacrolimus treated patients and almost blunted in patients receiving CsA. Similarily, ∼4% of B-cells in HS and even fewer in CsA or tacrolimus treated patients produced IL-10 (0.5% and 1.5%, p<0.05) and this was confirmed both in non-transplanted CsA-treated healthy subjects and in in vitro co-culture experiments. Among 29 patients with <1% of Breg, 9 cases (31%) displayed an allograft rejection in contrast to only one case of rejection (6%) among 17 patients with >1%. Conclusion: Calcineurin inhibitors reduce number and IL-10 production of Bregs in the peripheral circulation of both renal transplant recipients and non-transplanted healthy subjects. CNI induced Breg reduction is not restricted to a solid organ transplant setting and is not mediated by co-medication with steroids or MPA. A low proportion of Breg cells is associated with an elevated frequency of allograft rejection events. [ABSTRACT FROM AUTHOR]

Published
2016
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