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Endocan removal during continuous renal replacement therapy: does it affect the reliability of this biomarker?

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The Letter to this article has been published in Critical Care 2019 23:296

The original article was published in Critical Care 2018 22:280

We read the narrative review by De Freitas Caires et al. with great interest [1]. Acute kidney injury (AKI) is prevalent among patients with sepsis, and a substantial proportion of patients with sepsis-associated AKI (SA-AKI) require renal replacement therapy (RRT) [2]. Continuous RRT (CRRT) is increasingly used (~ 20% SA-AKI) among hemodynamically unstable septic shock patients [2]. Endocan as a novel endothelium-derived soluble dermatan sulfate proteoglycan has a molecular mass of around 20 kDa [3]. The contemporary CRRT membranes are able to remove molecules as large as 35 kDa. Hence, endocan could be removed by CRRT [4]. When new highly adsorptive membranes (HAM) with high absorptive abilities are used, the ability of CRRT to eliminate endocan could be even enhanced [4]. Therefore, the reliability of endocan during CRRT could be altered. De Freitas Caires et al. show that endocan appeared as a consistent good diagnostic criterion as well as procalcitonin (PCT) and could potentially be used for de-escalation therapy in the future (requiring new studies obviously) as PCT. Accordingly (if endocan is used for de-escalation in the future), falsely low endocan in CRRT patients, in turn, could lead to an earlier de-escalation of antibiotics and level of care for septic patients. There has been no investigation on the performance of endocan on patients who receive CRRT. Therefore, we believe there is a critical need for a future study with a focus on the performance of the currently known sepsis biomarkers among those who receive CRRT [5].

Abbreviations

AKI:

Acute kidney injury

CRRT:

Continuous renal replacement therapy

HAM:

Highly adsorptive membranes

PCT:

Procalcitonin

RRT:

Renal replacement therapy

SA-AKI:

Sepsis-associated AKI

References

  1. 1.

    De Freitas Caires N, Gaudet A, Portier L, Tsicopoulos A, Mathieu D, Lassalle P. Endocan, sepsis, pneumonia, and acute respiratory distress syndrome. Crit Care. 2018;22(1):280. https://doi.org/10.1186/s13054-018-2222-7.Review.

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    Peters E, Antonelli M, Wittebole X, Nanchal R, François B, Sakr Y, et al. A worldwide multicentre evaluation of the influence of deterioration or improvement of acute kidney injury on clinical outcome in critically ill patients with and without sepsis at ICU admission: results from The Intensive Care Over Nations audit. Crit Care. 2018;22(1):188. https://doi.org/10.1186/s13054-018-2112-z.

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    Lassalle P, Molet S, Janin A, Heyden JV, Tavernier J, Fiers W, et al. ESM-1 is a novel human endothelial cell-specific molecule expressed in lung and regulated by cytokines. J Biol Chem. 1996;271:20458–64.

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    Honoré PM, De Bels D, Spapen HD. An update on membranes and cartridges for extracorporeal blood purification in sepsis and septic shock. Curr Opin Crit Care. 2018;24(6):463–8. https://doi.org/10.1097/MCC.0000000000000542.

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    Honoré PM, Jacobs R, De Waele E, Van Gorp V, Spapen HD. Evaluating sepsis during continuous dialysis: are biomarkers still valid? Blood Purif. 2014;38(2):104–5. https://doi.org/10.1159/000363497 Epub 2014 Oct 17.

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PMH and KK designed the paper. All authors participated in drafting the manuscript. All authors have read and approved the final version.

Correspondence to Patrick M. Honore.

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This comment refers to the article available at https://doi.org/10.1186/s13054-018-2222-7.

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Honore, P.M., Bels, D., Attou, R. et al. Endocan removal during continuous renal replacement therapy: does it affect the reliability of this biomarker?. Crit Care 23, 184 (2019) doi:10.1186/s13054-019-2469-7

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