Continuous Renal Replacement Therapy in Pediatric Sepsis and MIS-C: Comparative Efficacy of Oxiris and Conventional...

In cases of sepsis and an excessive inflammatory response, continuous renal replacement therapy (CRRT) has the potential to provide immunomodulation by removing cytokines and inflammatory mediators. This study aimed to evaluate the efficacy of the Oxiris filter, which has endotoxin and cytokine adsorption properties, in the pediatric population and compare it with conventional filters.

This retrospective study examined 42 pediatric intensive care patients diagnosed with sepsis or multisystem inflammatory syndrome in children (MIS-C). The patients received CRRT with either Oxiris filters (n = 21) or conventional filters (n = 21). The study compared hemodynamic and laboratory parameters, as well as mortality.

The two groups had similar baseline characteristics and disease severity scores (PRISM III, PELOD II, and OFI). Overall mortality rates were comparable between the Oxiris and conventional filter groups (52.4% vs. 57.1%; p = 0.757), whereas 28-day mortality was significantly lower in the Oxiris group (28.6% vs. 61.9%; p = 0.030). Within 24 h, both filters showed comparable improvements in VIS, heart rate, mean arterial pressure (MAP), lactate, bicarbonate, and albumin levels (all p > 0.05); no significant changes were observed in C-reactive protein (CRP) or procalcitonin levels. Subgroup analysis revealed a more pronounced VIS reduction (p = 0.013), less adequate acidosis correction (p = 0.022), and higher PELOD-II scores (p = 0.026) among non-survivors. Thrombocytopenia was the most common complication, with no difference between the two groups.

In critically ill pediatric patients, Oxiris and conventional filters produced comparable short-term hemodynamic, metabolic, and inflammatory effects during CRRT. While overall mortality did not differ between the groups, 28-day mortality was lower in the Oxiris cohort. Further multicenter, prospective research is warranted to confirm these findings and to identify specific pediatric subgroups that may benefit from Oxiris therapy.