Immunothrombosis With Septic Shock Undergoing Renal Replacement Therapy With the OXIRIS Membrane

Inclusion criteria

• Patients aged 18 years and older
• Admitted to the intensive care unit with septic shock, defined as an increase in the Sequential Organ Failure Assessment (SOFA) score of at least 2 points due to infection, requiring vasopressor drugs to maintain a mean arterial pressure (MAP) ≥ 65 mmHg, and a lactate level > 2 mmol/L (18 mg/dL) despite adequate fluid resuscitation
• Requiring renal replacement therapy according to consensus indications:

• KDIGO stage 3 acute kidney injury with oliguria or anuria persisting for more than 72 hours
• Urea > 40 mmol/L
• Plasma potassium > 5.5 mmol/L despite medical treatment
• pH < 7.15 (pure metabolic acidosis with PaCO2 < 30 mmHg or mixed acidosis with PaCO2 > 50 mmHg without the possibility of improving alveolar ventilation)
• Acute pulmonary edema secondary to hydrosaline overload resulting in severe hypoxemia (oxygen flow > 5 L/min or FiO2 > 50% during mechanical ventilation to maintain SaO2 > 95%) despite diuretic therapy
• Receiving continuous renal replacement therapy with a high-adsorption membrane (oXiris membrane) or a conventional membrane (HF1400 membrane)

Exclusion criteria

• Known history of constitutional thrombopathy (Bernard Soulier disease, Glanzmann thrombasthenia, Gray's syndrome or dense granule disease)
• Myelodysplastic or myeloproliferative syndrome
• Autoimmune thrombocytopenic purpura
• Acute leukemia
• Hemorrhagic shock
• Platelet transfusion within 7 days prior to inclusion
• Antiplatelet therapy with clopidogrel or ticagrelor within 5 days prior to inclusion, prasugrel or dipyridamole within 7 days prior to inclusion
• Active HIV infection or hepatitis B or C
• Pregnant woman
• Not affiliated to a social security system or not benefiting from such a system