Sepsis is defined as organ failure caused by dysregulated host response to infection. While early antibiotic treatment in patients with acute infection is essential, treating non-infectious patients must be avoided. Current guidelines recommend procalcitonin (PCT) to guide discontinuation of antibiotic treatment. For initiation of therapy, there is currently no recommended biomarker. In this study, we evaluated Host-Derived Delta-like Canonical Notch Ligand 1 (DLL1), a monocyte membrane ligand that has shown promising results in differentiating infectious from non-infectious critically ill patients. Soluble DLL1 levels were measured in plasma samples of six different cohorts. The six cohorts comprise two cohorts with non-infectious inflammatory auto-immune diseases (Hidradenitis Suppurativa, Inflammatory Bowel Disease), one cohort of bacterial skin infection, and three cohorts of suspected systemic infection or sepsis. In total, soluble DLL1 plasma levels of 405 patients were analyzed. Patients were divided into three groups: inflammatory disease, infection, and sepsis (defined according to the Sepsis-3 definition), followed by the evaluation of its diagnostic performance via Area Under the Receiver Operating Characteristics (AUROC) analyses. Patients of the sepsis group showed significantly elevated plasma DLL1 levels compared to patients with uncomplicated infections and sterile inflammation. However, patients with infections had significantly higher DLL1 levels than patients with inflammatory diseases. Diagnostic performance was evaluated and showed better performance for DLL1 for the recognition of sepsis (AUC: 0.823; CI 0.731–0.914) than C-reactive protein (AUC 0.758; CI 0.658–0.857), PCT (AUC 0.593; CI 0.474–0.711) and White Blood Cell count (AUC 0.577; CI 0.46–0.694). DLL1 demonstrated promising results for diagnosing sepsis and was able to differentiate sepsis from other infectious and inflammatory diseases.

Background: Hepatic chemosaturation for inoperable liver tumors is a palliative treatment option with a beneficial effect on survival. However, the procedure regularly leads to circulatory failure during the filtration phase, and hemodynamic management is challenging. Our study aimed to compare two different strategies for hemodynamic management during chemosaturation to develop hypotheses for improving patient care and reducing peri-interventional morbidity. Methods: We conducted a single-center retrospective cohort study including 66 procedures of chemosaturation between May 2016 and March 2024. Procedures were divided into two groups: group 1 was managed with norepinephrine as the only vasopressor and liberal use of hydroxyethyl starch (HES). Group 2 was managed with norepinephrine and vasopressin and the preferred use of balanced crystalloids. We compared these two groups with respect to hemodynamic parameters, laboratory values, and post-interventional complications. Results: The heart rate was highest and the mean arterial pressure (MAP) was lowest during the filtration phase in both groups (p = 0.868, p = 0.270). The vasoactive inotropic score (VIS) was significantly higher in group 2 during the filtration phase (31.5 vs. 89, p < 0.001). Group 1 received significantly more HES overall (1000 mL vs. 0 mL, p < 0.001). Lactate levels at admission to the ICU were higher in group 1 (22.9 vs. 14.45 mg/dL, p = 0.041). Platelet counts were lower in group 2 from directly after chemosaturation through day 2 (p = 0.022, p = 0.001, p = 0.032). The INR differed significantly directly after chemosaturation (1.13 vs. 1.26, p = 0.015). Overall, group 1 received significantly more blood products peri-interventionally. There were two bleedings and one ischemic stroke in the overall cohort. There was no peri-interventional mortality. Conclusions: Advanced hemodynamic management ensures low peri-interventional mortality and morbidity. High-dose vasopressors, including vasopressin and the preferred use of balanced crystalloids, are sufficient to stabilize circulatory function during chemosaturation.

Background Hepatic chemosaturation using extracorporeal circulation (ECC) is associated with severe hemodynamic instability. Activated charcoal filters are used to prevent systemic toxicity, but their effects on circulating catecholamines remain poorly understood. Methods In this prospective, single-center observational study, systemic catecholamine concentrations were measured in 15 procedures undergoing hepatic chemosaturation. Blood samples were obtained at predefined time points: after induction of anesthesia (T0), during initiation of ECC (T1), immediately before (T2.1) and after charcoal filtration (T2.2) and after termination of ECC (T3). Results Systemic noradrenaline concentrations changed significantly over time (p < 0.001). The measured noradrenaline concentration increased markedly during inferior vena cava occlusion and ECC. This was consistent with pronounced hemodynamic instability and a significant increase in the dose of noradrenaline administered (T1 and T2.1 vs. T0), followed by a near-complete reduction across the activated charcoal filter (median extraction rate 95.5%) with continued high NA administration (median 0.35 µg/kg/min). In contrast, adrenaline and dopamine concentrations remained stable and were neither administered nor significantly affected by filtration. After termination of ECC, a pronounced rebound increase in noradrenaline concentrations was observed. These biochemical changes were accompanied by metabolic acidosis and rising lactate levels. Conclusion Activated charcoal filtration during hepatic chemosaturation selectively removes circulating noradrenaline and is a key contributor to perioperative hemodynamic instability. Awareness of this mechanism is essential for tailored vasopressor strategies and safer anesthetic management. Trial registration DRKS, DRKS00034527. Registered 24 June 2024, https://drks.de/search/de/trial/DRKS00034527

Background Hepatic chemosaturation using extracorporeal circulation (ECC) is associated with severe hemodynamic instability. Activated charcoal filters are used to prevent systemic toxicity, but their effects on circulating catecholamines remain poorly understood. Methods In this prospective, single-center observational study, systemic catecholamine concentrations were measured in 15 procedures undergoing hepatic chemosaturation. Blood samples were obtained at predefined time points: after induction of anesthesia (T0), during initiation of ECC (T1), immediately before (T2.1) and after charcoal filtration (T2.2) and after termination of ECC (T3). Results Systemic noradrenaline concentrations changed significantly over time (p < 0.001). The measured noradrenaline concentration increased markedly during inferior vena cava occlusion and ECC. This was consistent with pronounced hemodynamic instability and a significant increase in the dose of noradrenaline administered (T1 and T2.1 vs. T0), followed by a near-complete reduction across the activated charcoal filter (median extraction rate 95.5%) with continued high NA administration (median 0.35 µg/kg/min). In contrast, adrenaline and dopamine concentrations remained stable and were neither administered nor significantly affected by filtration. After termination of ECC, a pronounced rebound increase in noradrenaline concentrations was observed. These biochemical changes were accompanied by metabolic acidosis and rising lactate levels. Conclusion Activated charcoal filtration during hepatic chemosaturation selectively removes circulating noradrenaline and is a key contributor to perioperative hemodynamic instability. Awareness of this mechanism is essential for tailored vasopressor strategies and safer anesthetic management. Trial registration DRKS, DRKS00034527. Registered 24 June 2024, https://drks.de/search/de/trial/DRKS00034527

Background Hepatic chemosaturation using extracorporeal circulation (ECC) is associated with severe hemodynamic instability. Activated charcoal filters are used to prevent systemic toxicity, but their effects on circulating catecholamines remain poorly understood. Methods In this prospective, single-center observational study, systemic catecholamine concentrations were measured in 15 procedures undergoing hepatic chemosaturation. Blood samples were obtained at predefined time points: after induction of anesthesia (T0), during initiation of ECC (T1), immediately before (T2.1) and after charcoal filtration (T2.2) and after termination of ECC (T3). Results Systemic noradrenaline concentrations changed significantly over time (p < 0.001). The measured noradrenaline concentration increased markedly during inferior vena cava occlusion and ECC. This was consistent with pronounced hemodynamic instability and a significant increase in the dose of noradrenaline administered (T1 and T2.1 vs. T0), followed by a near-complete reduction across the activated charcoal filter (median extraction rate 95.5%) with continued high NA administration (median 0.35 µg/kg/min). In contrast, adrenaline and dopamine concentrations remained stable and were neither administered nor significantly affected by filtration. After termination of ECC, a pronounced rebound increase in noradrenaline concentrations was observed. These biochemical changes were accompanied by metabolic acidosis and rising lactate levels. Conclusion Activated charcoal filtration during hepatic chemosaturation selectively removes circulating noradrenaline and is a key contributor to perioperative hemodynamic instability. Awareness of this mechanism is essential for tailored vasopressor strategies and safer anesthetic management. Trial registration DRKS, DRKS00034527. Registered 24 June 2024, https://drks.de/search/de/trial/DRKS00034527

Background Hepatic chemosaturation using extracorporeal circulation (ECC) is associated with severe hemodynamic instability. Activated charcoal filters are used to prevent systemic toxicity, but their effects on circulating catecholamines remain poorly understood. Methods In this prospective, single-center observational study, systemic catecholamine concentrations were measured in 15 procedures undergoing hepatic chemosaturation. Blood samples were obtained at predefined time points: after induction of anesthesia (T0), during initiation of ECC (T1), immediately before (T2.1) and after charcoal filtration (T2.2) and after termination of ECC (T3). Results Systemic noradrenaline concentrations changed significantly over time (p < 0.001). The measured noradrenaline concentration increased markedly during inferior vena cava occlusion and ECC. This was consistent with pronounced hemodynamic instability and a significant increase in the dose of noradrenaline administered (T1 and T2.1 vs. T0), followed by a near-complete reduction across the activated charcoal filter (median extraction rate 95.5%) with continued high NA administration (median 0.35 µg/kg/min). In contrast, adrenaline and dopamine concentrations remained stable and were neither administered nor significantly affected by filtration. After termination of ECC, a pronounced rebound increase in noradrenaline concentrations was observed. These biochemical changes were accompanied by metabolic acidosis and rising lactate levels. Conclusion Activated charcoal filtration during hepatic chemosaturation selectively removes circulating noradrenaline and is a key contributor to perioperative hemodynamic instability. Awareness of this mechanism is essential for tailored vasopressor strategies and safer anesthetic management. Trial registration DRKS, DRKS00034527. Registered 24 June 2024, https://drks.de/search/de/trial/DRKS00034527