Predictive role of glutathione reductase and other RedOx markers in septic shock patients on continuous veno-venous hemofiltration treatment

At the current time there are contradictive data about a role of continuous veno-venous hemofiltration (CVVH) in treatment of the septic shock patients. The discrepancies could be explained by the various Reduction-Oxidation (RedOx) phenotypes among septic shock patients. The aim of the study was to check if RedOx markers are associated with the outcome of septic shock patients on CVVH treatment. Prospective study included 65 patients with septic shock (Sepsis-3 criteria) who was started on CVVH during the 12 hours after admission to ICU from January 2019 to August 2020. Blood samples were taken from each patient prior start of CVVH. The following RedOx markers were measured: total antioxidant state (TAS), glutathione peroxidase (GPx) superoxide dismutase (SOD), nitric oxide (NO), malondialdehyde (MDA), glutathione reductase (GR) and 4-hydroxynonenal (4-HNE). SPSS 23.0 software was used for the data analysis, odds ratio (OR) were calculated by using binary logistic regression and stepwise multivariable regression. Among study patients were 39/65 males, median of age 66 years (IQR 54-76,5), median of ICU stay 6 days (3-11). Based on the outcome all patients were divided into two groups: non-survivors 29/65 and survivors 39/65. Thereafter RedOx markers were compared among the groups. In non-survivors GR concentration is higher 100,3 U/L (IQR 71,8-149,9) in comparison to survivors – 60,5 U/L (IQR 45,0-93,4), OR 1,027 (95%CI 1,010-1,044). There were no associations with TAS (p=0,080), GPx (p=0,445), SOD (p=0,448), NO (p=0,119), MDA (p=0,567) and 4-HNE (p=0,079). Among septic shock patients on CVVH treatment high GR concentration is a strong predictor of fatal outcome. In septic shock patients high GR concentration represent hyperinflammatory host response.