Effect of CytoSorb Coupled with Hemodialysis on Interleukin-6 and Hemodynamic Parameters in Patients with Systemic Inflammatory Response Syndrome: A Retrospective Cohort Study

Abstract

Excessive release of cytokines during systemic inflammatory response syndrome (SIRS) often leads to refractory hypotension and multiple organ failure with high mortality. Cytokine removal with hemoadsorption has emerged as a possible adjuvant therapy, but data on interleukin-6 (IL-6) reduction and outcomes in clinical practice are scarce. We aimed to evaluate the effect of CytoSorb hemoadsorption on laboratory and clinical outcomes in shocked patients with SIRS. We designed a retrospective analysis of all patients with SIRS treated with CytoSorb in intensive care units (ICU). IL-6, laboratory and hemodynamic parameters were analyzed at approximate time intervals during CytoSorb treatment in the whole cohort and in a subgroup with septic shock. Observed and predicted mortality rates were compared. We included 118 patients with various etiologies of SIRS (septic shock 69%, post-resuscitation shock 16%, SIRS with acute pancreatitis 6%, other 9%); in all but one patient, CytoSorb was coupled with renal replacement therapy. A statistically significant decrease in IL-6 and vasopressor index with an increase in pH and mean arterial pressure was observed from 6 h onward. The reduction of lactate became significant at 48 h. Results were similar in a subgroup of patients with septic shock. Observed ICU and in-hospital mortalities were lower than predicted by Sequential Organ Failure Assessment (SOFA) (61% vs. 79%, p = 0.005) and Acute Physiology and Chronic Health Evaluation (APACHE) II (64% vs. 78%, p = 0.031) scores. To conclude, hemoadsorption in shocked patients with SIRS was associated with a rapid decrease in IL-6 and hemodynamic improvement, with improved observed vs. predicted survival. These results need to be confirmed in a randomized study.

A matched case-control study on the effectiveness of extracorporeal cytokine adsorption in critically ill patients

“…Finally, mortality was also not different between our unmatched and matched groups. This is in contrast to our retrospective study, where lower observed versus predicted mortality in patients treated with CytoSorb was reported 39 and in contrast to the propensity-score-weighted retrospective study, in which CytoSorb was associated with a decreased observed versus expected 28-day all-cause mortality compared with continuous renal replacement therapy alone 44 . On the other hand, our results are analogous to Scharf et al 38 , where matched groups had similar 2-day and in-hospital mortality.…”

“…Although comparable between groups, the noradrenaline requirement and serum lactate levels indicate that our patients (in general) were not at the high-end of the spectrum of hemodynamic instability. As reported previously, we tend to use Cytosorb relatively early, but only after a stabilization period, allowing for some patients to improve with SOC only 39 . It is noteworthy that a considerable proportion of our patients had an additional vasopressor, which is often used in ICU as a norepinephrine-sparing strategy.…”

“…To address this question, we additionally evaluated clinical efficacy of hemoadsorption in terms of hemodynamic stability, inflammatory markers and mortality. Early reports suggested lower vasopressor requirement 11 , 39 , 40 with the use of CytoSorb. A randomized study reported vasopressor requirement reduction in patients treated with adsorber for 24 hours, but not in the control group 17 .…”

A Contemporary Review of the Use of Extracorporeal CytoSorb® Hemoadsorption Therapy in Patients with Infective Endocarditis

“…However, the effect of CytoSorb ® hemoadsorption on hyperinflammation remains controversial across different clinical studies. Some observational studies suggest that CytoSorb ® may lower circulating cytokine concentrations, ameliorate organ dysfunction, and improve hemodynamics in critically ill patients with various hyperinflammatory conditions [34][35][36]. Similarly, a prospective, randomized single-center study by Garau et al showed that a significant short-term decrease in the proinflammatory cytokine levels of IL-8 and TNF-α at 6 h after CPB could be observed in patients undergoing on-pump cardiac surgery and intraoperative CytoSorb ® hemoadsorption [37].…”

Does adjunctive hemoadsorption provide benefit in the management of ischemia–reperfusion syndrome following near-drowning? A case report

“…The CytoSorb hemoadsorption column consists of coated polymer beads that capture hydrophobic molecules with a molecular weight of up to approximately 60 kDa (cytokines, bilirubin, bile acids, free hemoglobin, myoglobin, bacterial exotoxins, etc.) by surface adsorption and size exclusion ( 12 , 14 ). Data on the effect of CytoSorb in IRI per se are scarce.…”