Experience with hemoadsorption (CytoSorb®) in the management of septic shock patients

Yatin Mehta; Chitra Mehta; Ashish Kumar; Joby Varghese George; Aditi Gupta; Saurabh Nanda; Gourav Kochhar; Arun Raizada

doi:10.5492/wjccm.v9.i1.1

Experience with hemoadsorption (CytoSorb^®) in the management of septic shock patients

World J Crit Care Med. 2020 Jan 31;9(1):1-12. doi: 10.5492/wjccm.v9.i1.1.

Authors

Yatin Mehta¹, Chitra Mehta², Ashish Kumar², Joby Varghese George², Aditi Gupta², Saurabh Nanda², Gourav Kochhar², Arun Raizada²

Affiliations

¹ Medanta The Medicity, Gurgaon 122001, Haryana, India. yatin.mehta@medanta.org.
² Medanta The Medicity, Gurgaon 122001, Haryana, India.

Abstract

Background: Cytokines and inflammatory mediators are the hallmarks of sepsis. Extracorporeal cytokine hemoadsorption devices are the newer clinical support system to overcome the cytokine storm during sepsis.

Aim: To retrospectively evaluate the clinical outcomes of patients admitted in intensive care unit with septic shock with different etiologies.

Methods: The laboratory parameters including biomarkers such as procalcitonin, serum lactate and C-reactive protein; and the hemodynamic parameters; mean arterial pressure, vasopressor doses, sepsis scores, cytokine levels and other vital parameters were evaluated. We evaluated these outcomes among survivors and non-survivors.

Results: Of 100 patients evaluated, 40 patients survived. Post treatment, the vasopressors dosage remarkably decreased though it was not statistically different; 34.15% (P = 0.0816) for epinephrine, 20.5 % for norepinephrine (P = 0.3099) and 51% (P = 0.0678) for vasopressin. In the survivor group, a remarkable reduction of biomarkers levels; procalcitonin (65%, P = 0.5859), C-reactive protein (27%, P = 0.659), serum lactate (27%, P = 0.0159) and bilirubin (43.11%; P = 0.0565) were observed from baseline after CytoSorb^® therapy. A significant reduction in inflammatory markers; interleukin 6 and interleukin 10; (87% and 92%, P < 0.0001) and in tumour necrosis factor (24%, P = 0.0003) was also seen. Overall, 28 (28%) patients who were given CytoSorb^® therapy less than 48 h after onset of septic shock survived and the maximum duration of stay for 70% of these patients in intensive care unit was less than 15 d.

Conclusion: CytoSorb^® is a safe and well tolerated rescue therapy option in patients with septic shock. However, early (preferably within < 48 h after onset of septic shock) initiation could result in better clinical outcomes. Further randomized trials are needed to define the potential benefits of this new treatment modality.

Keywords: Clinical conditions; Cytokines; Hemoadsorption; Inflammation and extracorporeal; Sepsis.