Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jan 31, 2020; 9(1): 1-12
Published online Jan 31, 2020. doi: 10.5492/wjccm.v9.i1.1
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
Yatin Mehta, Chitra Mehta, Ashish Kumar, Joby Varghese George, Aditi Gupta, Saurabh Nanda, Gourav Kochhar, Arun Raizada, Medanta The Medicity, Gurgaon 122001, Haryana, India
Author contributions: Mehta Y, Mehta C, Kumar A and Raizada A contributed to study conception and design; George JV, Gupta A, Nanda S, and Kochhar G contributed to data acquisition, data analysis and interpretation, and writing of article; Mehta Y, Mehta C, and Kumar A contributed to editing, reviewing and final approval of article.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Institutional review board statement: this study was reviewed and approved by an institutional ethics committee.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: Yes, we have read the Strobe statement and prepared checklist and the manuscript accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yatin Mehta, FRCA, MD, MNAMS, Doctor, FAMS, FIACIA, FICCM, FIEE, Chairman, Institute of Critical Care and Anesthesiology, Medanta the Medicity, Sector 38, Gurgaon 122006, Haryana, India. yatin.mehta@medanta.org
Received: October 11, 2019
Peer-review started: October 11, 2019
First decision: November 1, 2019
Revised: December 23, 2019
Accepted: January 13, 2020
Article in press: January 13, 2020
Published online: January 31, 2020
Processing time: 121 Days and 20 Hours
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: Hemoadsorption; Sepsis; Cytokines; Clinical conditions; Inflammation and extracorporeal

Core tip: CytoSorb® is a promising new extracorporeal cytokine hemoadsorption device that can modulate the cytokine storm during sepsis. This retrospective study evaluated clinical outcomes after CytoSorb® therapy of 100 patients admitted to intensive care unit with sepsis. We observed a significant reduction in vasopressors dosage in 40 patients who survived. The survivors also had a reduction in all the biomarker levels (procalcitonin, C-reactive protein, serum lactate and bilirubin) and inflammatory markers (interleukin 6, interleukin 10 and tumour necrosis factor) after CytoSorb® therapy. Notably, 28% of patients who were given CytoSorb® therapy < 48 h after onset of septic shock survived.