The value of sequential extracorporeal therapy in management of septic patients phenotyping with hyperinflammation，high SOFA and refractory shock：a case report and systematic literature review

doi:10.3877/cma.j.issn.2096-1537.2025.02.020

Abstract

Abstract:

A retrospective analysis was conducted on the clinical data of a patient with septic shock due to a urinary tract infection admitted to Guiqian International Hospital on March 21，2024.Using the keywords “Sepsis” and “Blood purification”，a literature search was performed in the CNKI and Wanfang databases.A search with keywords “Sepsis” and “Blood purification” in title/abstract was also conducted in the PubMed database.Clinical outcomes were compared between groups receiving SET or not in patients phenotyping with the above characteristics.The results showed，this case was characterized with high expression of inflammatory factors，rapid progression of organ damage and refractory shock.Based on well implementing sepsis bundle，SET restored circulation and the other vital organ function rapidly，resulting in a favorable prognosis.A literature review searched out 12 cases with the similar characteristics to this case.Of them，8 patients showed rapid improvement of organ function and survival after receiving SET，but 4 patients died of severe complications.Additionally，4 cohort studies were recruited in the literature review.The pooled data demonstrated that SET significantly reduced inflammatory cytokines and improved patient outcomes.It was suggested that，based on well implementing bundles，SET could be one of the interventions beneficial to outcomes in septic patient phenotyping with the above characteristics.

Key words: Sepsis, Phenotype, Sequential extracorporeal therapy

Qing Hu, Dongxu Zhou, Mei Huang, Jincheng Qin, Wei Shi, Penglin Ma. The value of sequential extracorporeal therapy in management of septic patients phenotyping with hyperinflammation，high SOFA and refractory shock：a case report and systematic literature review[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(02): 210-216.

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治疗时间	HR（次/min）	BP（mmHg）	pH	BE（mmol/L）	Lac（mmol/L）	Pv-aCO₂ Gap（mmHg）	IIR（ml/h）	UO（ml/h）	NE [μg/(kg·min)]	VP（U/h）	IL-6（pg/ml）	PCT（ng/ml）	CRP（mg/L）
-6 h	128	82/53	7.12	-14.0	3.2	6	1000	20	1.00	1.0	/	/	/
0 h	112	72/55	7.18	-13.0	3.8	5	1000	20	1.00	1.0	>50 000	15.0	125
（第 1 次）
2 h	106	112/68	7.25	-10.5	3.3	6	600	50	0.80	1.0	/	/	/
4 h	107	120/87	7.30	-8.6	3.1	5	500	50～100	0.60	1.0	/	/	/
8 h	99	123/88	7.39	-6.8	2.0	4	300	100	0.50	0.5	/	/	/
12 h	99	136/82	7.38	-2.1	1.9	4	200	150	0.20	/	/	/	/
24 h	91	142/78	7.40	-0.8	2.1	5	200	100～200	0.10	/	21 134.2	10.5	113
（第 2 次）
48 h	77	146/83	7.42	1.0	1.5	4	100	100～200	0.08	/	1021.1	5.3	83
（第 3 次）
72 h	69	141/79	7.38	0.5	1.2	4	100	100～200	/	/	68.2	2.4	55

治疗时间	HR（次/min）	BP（mmHg）	pH	BE（mmol/L）	Lac（mmol/L）	Pv-aCO₂ Gap（mmHg）	IIR（ml/h）	UO（ml/h）	NE [μg/(kg·min)]	VP（U/h）	IL-6（pg/ml）	PCT（ng/ml）	CRP（mg/L）
-6 h	128	82/53	7.12	-14.0	3.2	6	1000	20	1.00	1.0	/	/	/
0 h	112	72/55	7.18	-13.0	3.8	5	1000	20	1.00	1.0	>50 000	15.0	125
（第 1 次）
2 h	106	112/68	7.25	-10.5	3.3	6	600	50	0.80	1.0	/	/	/
4 h	107	120/87	7.30	-8.6	3.1	5	500	50～100	0.60	1.0	/	/	/
8 h	99	123/88	7.39	-6.8	2.0	4	300	100	0.50	0.5	/	/	/
12 h	99	136/82	7.38	-2.1	1.9	4	200	150	0.20	/	/	/	/
24 h	91	142/78	7.40	-0.8	2.1	5	200	100～200	0.10	/	21 134.2	10.5	113
（第 2 次）
48 h	77	146/83	7.42	1.0	1.5	4	100	100～200	0.08	/	1021.1	5.3	83
（第 3 次）
72 h	69	141/79	7.38	0.5	1.2	4	100	100～200	/	/	68.2	2.4	55

序号	作者	原发病	感染部位	病原菌	休克	集束化治疗	使用的过滤器	SET 启动时间（h）	SET 后病情好转	28 d 存活	备注
1	Burov 等^[9]	脑肿瘤切除术后	尿路	未确定	是	是	CytoSorb	10	是	是
2	Burov 等^[9]	蛛网膜下腔出血	肺部	肺炎克雷伯菌	是	是	CytoSorb	20	是	否	脑出血
3	Burov 等^[9]	脑外伤	血流	表皮葡萄球菌	是	是	CytoSorb	10	是	是
4	Burov 等^[9]	蛛网膜下腔出血	血流	大肠埃希菌	是	是	CytoSorb	6	是	否	脑疝
5	Burov 等^[9]	蛛网膜下腔出血	血流	大肠埃希菌、摩根摩根菌	是	是	CytoSorb	20	是	否	脑疝
6	Burov 等^[9]	脑肿瘤切除术后	肺部	金黄色葡萄球菌	是	是	CytoSorb	6	48 h 内死亡	否	肺栓塞
7	Włochacz 等^[10]	药物过量、吸入性肺炎	血流	肺炎克雷伯菌	是	是	CytoSorb、oXiris	24	是	是
8	Tang 等^[11]	肝脓肿	血液	革兰氏阴性杆菌	是	是	Ha380	48	是	是
9	Ramírez-Guerrero 等^[12]	重症肺炎	血流	铜绿假单胞菌	是	是	oXiris	12	是	是
10	Sinkovic 等^[13]	淋巴瘤（化疗后）	肺部	肺炎球菌	是	是	CytoSorb	36	是	是	合并心功能障碍
11	De Rosa 等^[14]	脑膜炎	血流	B 群脑膜炎奈瑟菌	是	是	Toraymyxin、Septex 等	24	是	是	合并心功能障碍
12	Tang 等^[15]	胰腺炎、妊娠	腹腔	未确定	是	是	Ha330	24	是	是	胎儿死亡

序号	作者	原发病	感染部位	病原菌	休克	集束化治疗	使用的过滤器	SET 启动时间（h）	SET 后病情好转	28 d 存活	备注
1	Burov 等^[9]	脑肿瘤切除术后	尿路	未确定	是	是	CytoSorb	10	是	是
2	Burov 等^[9]	蛛网膜下腔出血	肺部	肺炎克雷伯菌	是	是	CytoSorb	20	是	否	脑出血
3	Burov 等^[9]	脑外伤	血流	表皮葡萄球菌	是	是	CytoSorb	10	是	是
4	Burov 等^[9]	蛛网膜下腔出血	血流	大肠埃希菌	是	是	CytoSorb	6	是	否	脑疝
5	Burov 等^[9]	蛛网膜下腔出血	血流	大肠埃希菌、摩根摩根菌	是	是	CytoSorb	20	是	否	脑疝
6	Burov 等^[9]	脑肿瘤切除术后	肺部	金黄色葡萄球菌	是	是	CytoSorb	6	48 h 内死亡	否	肺栓塞
7	Włochacz 等^[10]	药物过量、吸入性肺炎	血流	肺炎克雷伯菌	是	是	CytoSorb、oXiris	24	是	是
8	Tang 等^[11]	肝脓肿	血液	革兰氏阴性杆菌	是	是	Ha380	48	是	是
9	Ramírez-Guerrero 等^[12]	重症肺炎	血流	铜绿假单胞菌	是	是	oXiris	12	是	是
10	Sinkovic 等^[13]	淋巴瘤（化疗后）	肺部	肺炎球菌	是	是	CytoSorb	36	是	是	合并心功能障碍
11	De Rosa 等^[14]	脑膜炎	血流	B 群脑膜炎奈瑟菌	是	是	Toraymyxin、Septex 等	24	是	是	合并心功能障碍
12	Tang 等^[15]	胰腺炎、妊娠	腹腔	未确定	是	是	Ha330	24	是	是	胎儿死亡

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