Successful use of CytoSorb in a Covid-19 patient with secondary septic shock due to a sacral decubitus infection.

Abstract

Septic shock is a clinical condition with high mortality (40%-70%) and morbidity. During septic shock, there is a significant release of cytokines and other inflammatory mediators that can cause damage to different organs, known as a "cytokine storm." The cytokine storm can cause hypotension, tissue damage, metabolic acidosis, and renal failure. This clinical picture also seems to be confirmed in the context of Covid-19 patients. Hemoadsorption with CytoSorb represents an adjunctive therapy to attenuate the systemic inflammatory process and helps restore a balanced immune response. We present the clinical case of a 75-year-old man, admitted to our hospital with respiratory failure due to Sars-CoV-2 infection and secondary septic shock due to a sacral decubitus. On admission the patient presented with a clinical picture of mixed acidosis with high levels of lactate and inflammatory indexes. Simultaneously along with antibiotic therapy, we started hemoadsorption treatment with CytoSorb in combination with continuous venous-venous hemodiafiltration. At the end of the treatment the patient had recovered his vital functions and the infection was successfully treated. Use of the CytoSorb device in a Covid-19 positive patient was safe and well-tolerated. Early treatment with CytoSorb decreased interleukin 6 plasma levels and inflammatory indexes, resulting in earlier stabilization of homeostasis. This case report suggests that the use of CytoSorb could be a possible adjuvant therapy in patients with septic shock even when affected by Covid-19.