Abstract
BackgroundA cytokine storm is life threatening for critically ill patients and is mainly caused by sepsis or severe trauma. In combination with supportive therapy, the cytokine adsorber Cytosorb® (CS) is increasingly used for the treatment of cytokine storm. However, it is questionable whether its use is actually beneficial in these patients.MethodsPatients with an interleukin-6 (IL-6) > 10,000 pg/ml were retrospectively included between October 2014 and May 2020 and were divided into two groups (group 1: CS therapy; group 2: no CS therapy). Inclusion criteria were a regularly measured IL-6 and, for patients allocated to group 1, CS therapy for at least 90 min. A propensity score (PS) matching analysis with significant baseline differences as predictors (Simplified Acute Physiology Score (SAPS) II, extracorporeal membrane oxygenation, renal replacement therapy, IL-6, lactate and norepinephrine demand) was performed to compare both groups (adjustment tolerance: < 0.05; standardization tolerance: < 10%). U-test and Fisher’s-test were used for independent variables and the Wilcoxon test was used for dependent variables.ResultsIn total, 143 patients were included in the initial evaluation (group 1: 38; group 2: 105). Nineteen comparable pairings could be formed (mean initial IL-6: 58,385 vs. 59,812 pg/ml; mean SAPS II: 77 vs. 75). There was a significant reduction in IL-6 in patients with (p < 0.001) and without CS treatment (p = 0.005). However, there was no significant difference (p = 0.708) in the median relative reduction in both groups (89% vs. 80%). Furthermore, there was no significant difference in the relative change in C-reactive protein, lactate, or norepinephrine demand in either group and the in-hospital mortality was similar between groups (73.7%).ConclusionOur study showed no difference in IL-6 reduction, hemodynamic stabilization, or mortality in patients with Cytosorb® treatment compared to a matched patient population.
Highlights
There is no uniform definite clinical picture of a “cytokine storm”, it involves a massive release of cytokines into the bloodstream [1]
The underlying diseases resulting in admission to the Intensive care unit (ICU) in patients allocated to group 1 were as follows: septic shock (47.4%), acute respiratory distress syndrome (ARDS, 36.8%), polytrauma (7.9%), and others (7.9%)
The underlying diseases resulting in admission to the ICU in patients allocated to group 2 were as follows: sepsis (21.0%), urosepsis (15.2%), septic shock (15.2%), ARDS (13.3%), hemorrhagic shock (8.6%), pneumonia (6.7%), polytrauma (4.8%), and others (15.2%)
Summary
There is no uniform definite clinical picture of a “cytokine storm”, it involves a massive release of cytokines into the bloodstream [1]. A wide variety of etiologies can trigger cytokine storm, the most common being sepsis, severe trauma, liver failure, and CART-T cell therapy [2, 3]. In the case of septic shock, the infection leads to an activation of the immune system and results in the release of cytokines [5]. A cytokine storm is life threatening for critically ill patients and is mainly caused by sepsis or severe trauma. In combination with supportive therapy, the cytokine adsorber Cytosorb® (CS) is increasingly used for the treatment of cytokine storm. It is questionable whether its use is beneficial in these patients
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