The pattern of cytokine profile in children received extracorporeal blood purification

Abstract

We reported the cytokine profile in children <18 years old who received extracorporeal blood purification (EBP) for sepsis, rhabdomyolysis, hyperbilirubinaemia, acute respiratory distress syndrome or cytokine storm, and determined the factors affecting the cytokine removal kinetics. Plasma levels of 38 types of cytokine/chemokine were measured at pre-EBP, 12 and 24 h after initiating EBP. Altogether there were 11 eligible episodes admitted between April 2021 and December 2023. 72.7% were male with a median (25th, 75th percentile) age of 8.7 (5.4, 15.7) years old. The overall mortality rate was 45.5% but there was no EBP-associated mortality. EBP modalities included Cytosorb^® haemoadsorption (63.6%) and Oxiris^® haemodiafiltration (36.4%). Thirty-seven (97.4%) cytokines exhibited a concentration reduction following EBP, and 60.5% achieved a ≥50% concentration reduction. The median removal ratio was 35.0 (21.0, 53.7)% at 12 h and 55.0 (42.1, 83.1)% at 24 h. Survivors showed a significantly higher number of cytokines with ⩾50% removal ratio at 24 h (28 vs 7, p = 0.017) and better removal ratio of anti-inflammatory cytokines at 12 h (67.9% vs 0%, p = 0.030). A higher pre-EBP cytokine concentration and higher blood flow rate were significantly associated with better removal in 16 (42.1%) and 32 (84.2%) cytokines respectively. Our study demonstrated that both devices can safely and effectively reduce the cytokine and chemokine levels in critically ill children with various conditions.