Abstract
Introduction: Despite advances in critical care medicine, adjunctive approaches in sepsis therapy have failed to prove their efficacy. Notwithstanding promising results using hemoadsorption (CytoSorb), questions remain concerning timing and dosing. We created a dynamic scoring system (DSS) to assess patients with early septic shock and performed a first evaluation of the system in this patient population. Methods: Data from 502 patients with septic shock according to Sepsis-3 criteria were retrospectively analyzed. Score parameters were documented at the time of diagnosis (T0) and 6 h later (T6) to calculate a dynamic score. Survival on day 7 and 56 as well as ICU and hospital mortality were analyzed in regard to the score as well as the delay of hemoadsorption therapy. Results: Of the 502 patients analyzed, 198 received adjunctive CytoSorb treatment and 304 received standard therapy. Septic shock was typically represented by 5 points, while >6 points indicated a situation refractory to standard therapy with the worst outcome in patients shown by >8 points. The differences in mortality between the score groups (<6, 6–8, >8 points) were significant. Analysis further showed a significant 56-day, ICU and hospital survival advantage in CytoSorb patients when therapy was started early. Conclusion: We created a scoring system allowing for the assessment of the clinical development of patients in the early phase of septic shock. Applying this approach, we were able to detect populations with a distinct mortality pattern. The data also showed that an early start of CytoSorb therapy was associated with significantly improved survival. As a next step, this easy-to-apply scoring system would require validation in a prospective manner to learn whether patients to be treated with hemoadsorption therapy in the course of septic shock could thereby be identified.
Highlights
The APACHE 2 Score and intensive care units (ICU) and hospital days, there were no significant differences between the groups
Significant differences were found in age, SAPS 2, ventilation days, ICU and hospital mortality, all of which scored items and points in the dynamic scoring system (Table 1)
Significant differences were found in age, SAPS 2, ventilation days, hospital mortality and time delay until start of therapy, all of which scored items without T0 lactate and points in the dynamic scoring system (Table 2)
Summary
Sepsis represents a major challenge for medicine and a significant public health concern [1]. Despite all medical advances in recent years, it continues to be a substantial problem, as to date therapeutic approaches have failed to prove efficacy [2]. Sepsis has major importance from a medical and from an economical viewpoint. Approaches that could contribute to its successful treatment need to be further explored [3]
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