P1065EXTRACORPOREAL CYTOKINE ADSORPTION IN PATIENTS WITH AKI AND SEPTIC SHOCK AFTER CARDIAC SURGERY

Abstract

Abstract Background and Aims Extracorporeal cytokine adsorption is a new option in septic shock as an additional measure to prevent severe cytokinaemia. The purpose of this study was to investigate the effects of extracorporeal cytokine adsorption on hemodynamics in patients with acute kidney injury (AKI) and septic shock after cardiac surgery. Method In this retrospective study 64 patients with AKI and septic shock after cardiac surgery were investigated for the effect of extracorporeal cytokine adsorption by CytoSorb® columns on hemodynamics. In all patients CytoSorb®-treatment was applied in addition to continuous renal replacement therapy (CRRT) with citrate anticoagulation. A paired t-test has been performed to determine statistical significance. Results Before treatment, the mean noradrenalin dose to reach a mean arterial pressure (MAP) > 65 mmHg was 0.49 µg/kg bw/min, the mean adrenalin dose was 0.1 µg/kg bw/min. 24 h after treatment, significantly reduced catecholamine doses were necessary to maintain a MAP > 65 mmHg (0.23 µg/kg bw/min noradrenalin; p***< 0.0002 and 0.06 µg/kg bw/min adrenalin; p* < 0.02). The mean SOFA-score for these patients with AKI and septic shock 24 h before CytoSorb®- treatment was 16.6 points. The mean predicted in-hospital mortality rate based on this SOFA-score of 16.6 points was 77 % while the all-cause mortality rate of the patients in this study was 59.4 %. Conclusion In patients with AKI and septic shock after cardiac surgery, 24 h after extracorporeal cytokine adsorption by CytoSorb® the catecholamine dose required to maintain a MAP > 65 mmHg was halved. Additionally, observed in-hospital mortality was lower than SOFA-score predicted mortality.