Retrospective evaluation of efficacy of CytoSorb® therapy in septic shock patients in a tertiary care intensive care unit

Abstract

Background: Cytokines and inflammatory mediators are the key factors that are involved in the pathology of sepsis. Extracorporeal cytokine hemoadsorption devices offer an innovative clinical support system to alleviate the effects of the cytokine storm associated with sepsis.

Aim: To retrospectively evaluate the efficacy of CytoSorb^® therapy as an adjunct to standard care in intensive care unit (ICU) patients with septic shock.

Methods: A retrospective study was designed. Data were obtained for the patients who were treated with the CytoSorb^® adsorber for the past 5 years. The effects of therapy were assessed by changes in vasopressor requirements, specifically, norepinephrine and epinephrine. In addition, cytokine levels, such as interleukin (IL)-6 and inflammatory biomarkers including C-reactive protein (CRP), procalcitonin, as well as substances such as serum lactate and lactate dehydrogenase were also evaluated. In addition, mean arterial pressure (MAP) and ventilator requirements were also recorded. The survival outcomes were analyzed based on the length of patients' stay in the ICU, and the severity of illness was assessed using Acute Physiology and Chronic Health Evaluation (APACHE II) and Sepsis-associated Organ Failure Assessment (SOFA) scores recorded at baseline and post-therapy.

Results: Following CytoSorb^® therapy, the requirement for vasopressor drugs, particularly norepinephrine, was reduced by 40% and a statistically significant improvement in MAP by 7.8%. Additionally, significant reductions were observed in IL-6 and serum lactate levels by 83% and 52% respectively. Around 56% had a delta lactate score of > 1.5, while 23% patients had a score ranging from 1 to < 1.5, and 16% patients had a score between 0.5 and < 1 and merely 5% patients had a score of ≤ 0.5. Besides, serum levels of creatinine, procalcitonin and CRP were significantly reduced by 17.2%, 41.5% and 53.8% respectively. There was a significant reduction in scores, including APACHE II [to 23 (18-29) from 27 (23-33)], and SOFA [to 12 (10-14) from 13 (11-15)]. Mechanical ventilation was required by 96% patients, with a median duration of 12 days, and the median length of hospital stay in overall patients was 26 days, while the median ICU stay was 18 days.

Conclusion: CytoSorb^® therapy seems to be a promising adjunctive approach in the management of septic shock.

Keywords: Acute Physiology and Chronic Health Evaluation scores; CytoSorb® therapy; Cytokine hemoadsorption; Mean arterial pressure; Mechanical ventilation; Sepsis associated organ failure scores; Septic shock.

Figure 1

Pathophysiology of septic shock. PAMPs: Pathogen-associated molecular Patterns; DAMPs: Damage-associated molecular patterns; PMN: Polymorphonuclear neutrophils; TNF: Tumor necrosis factor; IL: Interleukin; TGF: Transforming growth factor; HAI: Healthcare-associated infections; MODS: Multiple organ dysfunction syndrome.

Figure 2

Key features of the cytoSorb therapy. A: CytoSorb adsorber-bead based technology; B: CytoSorb size selective removal.

Figure 3

Sepsis severity and prognosis. A: Delta lactate score classification; B: Comparison of sepsis scores; C: Delta sepsis associated organ failure score classification. SOFA: Sepsis Associated Organ Failure; APACHE II: Acute Physiology and Chronic Health Evaluation; PRE: Values recorded pre/before CytoSorb; POST: Values recorded post/after CytoSorb.

Figure 4

Time to initiate CytoSorb after intensive care unit admission. ICU: Intensive care unit.

Figure 5

Treatment flowchart[11,21,29]. SOC: Standard of Care; NE: Norepinephrine; IL: Interleukin.