Mehta Y, Paul R, Ansari AS, Banerjee T, Gunaydin S, Nassiri AA, Pappalardo F, Premužić V, Sathe P, Singh V, Vela ER. Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements. World J Crit Care Med 2023; 12(2): 71-88 [PMID: 37034019 DOI: 10.5492/wjccm.v12.i2.71]
Corresponding Author of This Article
Yatin Mehta, MBBS, MD, Chairman, Institute of Critical Care and Anesthesiology, Medanta the Medicity, Sector 38, Gurugram 12201, India. yatin.mehta@medanta.org
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Systematic Reviews
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Rapid hemodynamic stabilization; Reduction in Vasopressor dose by 67%; Decrease in blood lactate by 26.4%; Shock reversal in 38.5% patients; Decreased mortality than predicted by APACHE II; No adverse events reported
Reduced observed mortality of 65% than predicted by APACHE II of 78%; Marked reduction in IL6 levels; No significant reduction in SOFA scores; Safe and well tolerated without any adverse events
In CytoSorb group, the mean predicted mortality rate was 74.5%, while 28 d mortality rate was 47.8%; In CRRT group, the mean predicted mortality rate was 67.9%, while 28-d mortality was 51.0%; CytoSorb group was associated with a reduced 28-d mortality in comparison to CRRT (53% vs 72.3%)
CytoSorb hemoperfusion (Survivor group vs non survivor group)
Improvement in MAP (62.82 ± 9.73mmHg); Reduction in vasopressor dose; Reduction IL-6 levels (87%) and TNF levels (24%); Decrease in SOFA scores by 16.2%
Prospective, real time, observational multicentre study
45 septic shock patients
CytoSorb+ Standard therapy
26 patients survived post therapy; Reduction in vasopressor dose (NE- 51.4%, Epinephrine – 69.4% and Vasopressin -13.9%); 52.3% reduction in IL-6 levels; Reduction in APACHE II and SOFA scores, 20.1 ± 2.47 and 9.04 ± 3.00 respectively
The 30-d mortality rate was 0% in CytoSorb group, whereas 57% was observed in control group; Significant reduction in procalcitonin and C-reactive levels were observed in CytoSorb group in comparison to control group
42 septic shock patients compared to 42 matched controls
Cytosorb +RRT
Catecholamines requirements decreased to 0.26 µg/kg/min within 24 h of therapy with CytoSorb; In hospital mortality was significantly lower in CytoSorb group as compared to controls (35.7% vs 61.9%); Risk factors in CytoSorb group were high lactate levels and low thrombocyte counts proior to therapy. Lactate value of 7.5 mmol/L, predicted mortality with high specificicty (88.9%)
Table 3 Studies determining efficacy of CytoSorb in coronavirus disease 2019 infection
CytoSorb hemoperfusion other prescribed medications (tocilizumab, antivirals, hydroxychloroquine, azithromycin)
Significant improvement in biochemical parameters and clinical outcomes post CytoSorb therapy; Reduction in CRP levels by 91.5%, 97.4% and 55.75%, respectively; Improvement in MAP by 18%, 23% and 17% by 7th day post therapy
21 patients survived; Significant decrease in NE requirement; PCT, CRP and ferritin reduced post therapy; Significant improvement in SOFA scores; Therapy was well tolerated
ICU mortality was 17.3% on day 30, 26.9% on day 90, and 30.8% at final follow up of 143 d; Lower baseline D-Dimer levels were observed among survivors (2.3 ± 2.5 vs 19.8 ± 32.2 µg/mL) compared to non survivors; Borderline association observed between baseline D-Dimer levels and mortality with a 32% increase in risk of death per 1 µg/mL increase
Table 4 Multiple logistic regression analysis to predict 30 d mortality
24 h, Can be administered up to 7 consecutive days
Depending on mode of operation: Hemoperfusion 100-250 mL/ min; Dialysis < 320 ml/ min with use upto 4 h; CRRT 150-250 mL/min with use upto 12 h; CPB up to 700 mL/ min with use upto 2.5 h
120-180 min, Not suggested to use more than 3 times within 24 h
Reduction in CRP, ferritin, fibrinogen and other inflammatory mediators were observed
Citation: Mehta Y, Paul R, Ansari AS, Banerjee T, Gunaydin S, Nassiri AA, Pappalardo F, Premužić V, Sathe P, Singh V, Vela ER. Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements. World J Crit Care Med 2023; 12(2): 71-88