Alteration in serum albumin, magnesium, and phosphorus levels during hemadsorption with oXiris® in critically ill patients with septic shock

Rationale: Multiple research studies have provided evidence supporting the effectiveness of early implementation of oXiris® hemadsorption in mitigating hyperinflammation and enhancing hemodynamic among individuals with septic shock. However, further investigation is needed to fully understand its potential impact on the removal of albumin, magnesium (Mg) and phosphorus (P).

Methods: This observational study was conducted in the intensive care unit (ICU) of a tertiary care center in Latvia from January to March 2023. The study included seven adult patients with septic shock caused by gram-negative bacteria who were undergoing continuous veno-venous hemofiltration (CVVH) with oXiris®. The objective of the study was to investigate the reduction of serum albumin levels during hemadsorption therapy in patients who did not receive nutrient supplementation during the early phase of septic shock. Statistical analyses, including appropriate tests such as paired t-tests or Wilcoxon signed-rank tests, were conducted to evaluate the significance of the observed changes in serum albumin, Mg, and P levels before and after 48 hours of hemadsorption therapy with oXiris®.

Results: The median age of the patients included in the study was 55 years (interquartile range [IQR]: 51-56). The median pre-treatment dose of norepinephrine (NE) was 0.24μg/kg/min (IQR: 0.18 – 0.43), Endotoxin (EU/L; median 0.5, IQR 0.47-0.75), Procalcitonin (PCT; 58; IQR: 31-96). Hemadsorption therapy with oXiris® was initiated in all patients within 3 hours (IQR: 3;17) of ICU admission and after 48 h of CVVH, median NE dose, Endotoxin and PCT levels decreased by 0.18 μg/kg/min (66%), 0.33EU/ml (85%); 34ng/ml (22%) respectively. Additionally, significant reductions were observed after 48 hours of hemadsorption therapy with oXiris® in serum albumin levels (median level: 29.5 g/L [IQR: 28.3;30.8] vs 24.5 g/L [IQR: 22.5;25.8], p=0.031), Mg levels (0.8 mmol/L [IQR: 0.77;0.82] vs 0.59 mmol/L [IQR: 0.57;0.63], p=0.016), and P levels (1.32 mmol/L [IQR: 1.1;1.98] vs 0.98 mmol/L [IQR: 0.85;1.03], p=0.047).

Conclusion: Statistically significant decrease in albumin and electrolyte levels was observed after 48 hours of treatment. These results highlight the need for further research to better understand the impact of hemadsorption membranes on albumin and electrolyte loss. Additionally, there is a need to develop strategies for individualized case management in order to mitigate these potential complications.