Hemoadsorption in ‘Liver Indication’—Analysis of 109 Patients’ Data from the CytoSorb International Registry

Abstract

Background: Our aim is to report the results of the ‘liver indication’ subset of patients in the CytoSorb International Registry. Methods: Structured data were recorded. Treatment characteristics and changes from T1 (start of hemoadsorption) to T2 (termination) were evaluated with a special focus on bilirubin, C-reactive protein, procalcitonin, interleukin-6, platelet levels, SOFA scores, mortality, and subjective assessment by the attending physicians. Results: Until January 2021, from the total 1434 patients, 109 (age: 49.2 ± 17.1 years, 57.8% males) received treatment for hyperbilirubinemia. APACHE II-predicted mortality was 49.6 ± 26.8%. In the study, 91% of patients were alive at the termination of hemoadsorption and improvement was observed by the physicians in 75 cases. Overall, 65 (59.6%) patients died in the hospital, and 60 (55.0%) died in the ICU. Patients received a median of two treatments for a median of 43 h (interquartile range: 24–72 h) in total. Serum bilirubin levels reduced significantly to −4.6 (95% CI: −6.329 to −2.8) mg/dL. Thrombocytopenia was reported in four patients as an adverse event. Conclusions: We report the largest case series on hemoadsorption for ‘liver indication’ from the CytoSorb International Registry. The finding of significant bilirubin removal observed in our study could have substantial impact in designing and executing further studies on the effects of hemoadsorption in liver dysfunction, which are certainly warranted.

The successful application of hemoadsorption for extracorporeal liver support in a child with acute liver failure

“…3 However, a recent in-vitro study demonstrated a superior bilirubin removal and comparable bile acids removal efficacy by Cytosorb ® compared to MARS. 8 The largest cohort of Cytosorb ® use for hyperbilirbinemia comprising 109 critically ill adults reported a mean drop of bilirubin level of 78.2 μmol/L after a median treatment of two sessions lasting for 43 h. 5 Our own experience also showed that hemoadsorption may have the merits of a faster initial rate of bilirubin removal and ease of set up compared to albumin dialysis.…”

“…1 It has been demonstrated that the use of extracorporeal liver support (ECLS) system is associated with a reduced mortality. 2 There are a number of different ECLS modalities including single-pass albumin dialysis (SPAD), 3 molecular adsorbent reticulating system (MARS), 3 fractionated plasma separation and adsorption (Prometheus ® ), 3 therapeutic plasma exchange (TPE), 4 and hemoadsorption, 5 but no single modality is superior to the others as large-scale trials directly comparing their efficacy is lacking. In recent years, hemoadsorption has re-attracted attention with the introduction of a new sorbent Cytosorb ® , which is made of biocompatible porous polymer beads that is capable of removing hydrophobic molecules up to the size of 55–60 kDa.…”

Hemoperfusion in the intensive care unit

“…Both in children and in adults, CytoSorb ® has been used to significantly and effectively reduce bilirubin and myoglobin serum concentrations, proving itself as a potential tool for patients with different forms of liver failure with hyperbilirubinemia [55,56] and rhabdomyolysis [57,58].…”

Cytokine mass balance levels in donation after circulatory death donors using hemoadsorption: Case series report

“…9,10 Severals of publications reported on its innate ability to reduce inflammatory parameters (C-reactive protein [CRP], procalcitonin [PCT], Interleukin [IL]-6, tumor necrosis factor [TNF]-α). 11…”

“…9,10 Severals of publications reported on its innate ability to reduce inflammatory parameters (C-reactive protein [CRP], procalcitonin [PCT], Interleukin [IL]-6, tumor necrosis factor [TNF]-α). 11 This observational pilot paper describes a case series of DCD donors measuring inflammatory cytokine levels under hemoadsorption treatment during NRP.…”