Published online Jan 31, 2020. doi: 10.5492/wjccm.v9.i1.1
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
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.
To retrospectively evaluate the clinical outcomes of patients admitted in intensive care unit with septic shock with different etiologies.
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.
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.
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.
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.