Abstract
Hemoadsorption with CytoSorb® offers a possible therapeutic approach in septic shock, but modes of application and dosing are still undetermined. Data from surgical patients with septic shock, treated with hemoadsorption adjunctive to renal replacement therapy were analyzed retrospectively. The 28-day mortality was compared to predicted mortality. In 70 patients (70.6 ± 13.3 years), hemoadsorption was applied for 85.6 ± 53.8 h. The APACHE ll (30.2 ± 6.3) calculated to a predicted mortality of 73.3%, while the observed mortality was significantly lower (50%, p < 0.05). The amount of blood purified was higher in survivors than in non-survivors (8.5 ± 4.4 vs. 6.1 ± 3.6 l/kgBW, p = 0.017). We identified three clusters of <6 l/kgBW, 6-13 l/kgBW and ≥ 13 l/kgBW with a linear dose-response relation between blood purification volume and survival, which was best in the highest volume cluster (83.3%; p = 0.045). The application of CytoSorb® seems to be effective in various conditions of septic shock. In a cohort of most severely ill patients the observed mortality was lower than predicted and decreased linearly with blood purification volumes inadvertently exceeding 6 l/kg BW. These results suggest that hemoadsorption might improve survival provided that the applied dose is high enough.
Highlights
Septic shock and systemic inflammatory response syndrome (SIRS) are life-threatening diseases with persistent high mortality
In a cohort of severely ill patients the observed mortality rate was lower than predicted and decreased linearly with blood purification volumes exceeding 6l/kg BW. These results suggest that hemoadsorption with CytoSorb® improves survival in septic shock or SIRS, provided that the applied dose is high enough
Between March 2016 and January 2019, 286 patients with septic shock were admitted to the intensive care unit with septic shock according to the sepsis-3 criteria [36], characterized by a serum lactate concentration > 2 mmol/l and vasopressor requirement despite fluid resuscitation for achieving a mean arterial pressure (MAP) of > 65 mmHg. 96 patients with acute renal failure acute kidney injury (AKI) II [37] were treated with continuous veno-venous hemodialysis (CVVHD) and additional hemoadsorption [28, 33]
Summary
Septic shock and SIRS are life-threatening diseases with persistent high mortality. Sepsis and septic shock are complex, life-threatening organ dysfunction caused by an inadequate, misdirected host response to infection [1] with persistent high mortality and morbidity [2, 3]. Cytokines are an important part of the inflammatory reaction [8,9,10,11,12]. The misregulated, excessive release of pro-inflammatory cytokines leads to a generalized inflammatory reaction with autodestructive potential (so-called cytokine storm). Up-regulation of anti-inflammatory cytokines (IL-10) is intended to prevent an overreaction of the immune system [13] which may lead to immune paralysis with secondary, potentially fatal infection [14,15,16]
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