Impact of CytoSorb® on interleukin-6 in cardiac surgery

Abstract

ObjectiveCardiac surgery is known to activate a cascade of inflammatory mediators leading to a systemic inflammatory response. Hemadsorption (HA) devices such as CytoSorb® have been postulated to mitigate an overshooting immune response, which is associated with increased morbidity and mortality, and thus improve outcome. We aimed to investigate the effect of CytoSorb® on interleukin (IL)-6 levels in patients undergoing complex cardiac surgery in comparison to a control group.MethodsA total of 56 patients (28 CytoSorb®, 28 control) undergoing acute and elective cardiac surgery between January 2020 and February 2021 at the Department of Cardiac and Vascular Surgery, Clinic Floridsdorf, Vienna, were retrospectively analyzed. The primary endpoint was the difference in IL-6 levels between the CytoSorb® and control group. Secondary endpoint was periprocedural mortality.ResultsCytoSorb®, installed in the bypass circuit, had no significant effect on IL-6 levels. IL-6 peaked on the first postoperative day (HA: 775.3 ± 838.4 vs. control: 855.5 ± 1,052.9 pg/ml, p = 0.856). In total, three patients died in the HA group, none in the control (logistic regression model, p = 0.996). Patients with an increased Euroscore II of 7 or more showed a reduced IL-6 response compared to patients with an Euroscore II below 7 (178.3 ± 63.1 pg/ml vs. 908.6 ± 972.6 pg/ml, p-value = 0.00306).ConclusionsNo significant reduction of IL-6 levels or periprocedural mortality through intraoperative HA with CytoSorb® in patients undergoing cardiac surgery was observed. However, this study was able to show a reduced immunologic response in patients with a high Euroscore II. The routine application of CytoSorb® in cardiac surgery to reduce inflammatory mediators has to be scrutinized in future prospective randomized studies.

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

“…Cardiac surgery may activate the host immune system through surgical trauma, CPB, artificial surfaces, or ischemia-reperfusion injury, which might further lead to systemic inflammatory response syndrome (SIRS) [17,18]. In 2017, a retrospective cohort study enrolling 28,513 patients revealed that the overall prevalence of postoperative SIRS within the first 24 h after cardiac surgery was as high as 58.7% [19].…”

“…In contrast, another randomized controlled trial enrolling 30 patients undergoing elective cardiac surgery showed that CytoSorb ® hemoadsorption failed to reduce both pro-and anti-inflammatory cytokines [38]. More recently, Daniela et al performed a retrospective study with 56 participants to investigate whether the use of CytoSorb ® has an effect on IL-6 levels in patients undergoing cardiac surgery [17]. The results showed that IL-6 levels peaked on the first postoperative day in both the CytoSorb ® and control groups (CytoSorb ® : 775.3 ± 838.4 vs. control: 855.5 ± 1052.9 pg/mL) and that intraoperative CytoSorb ® hemoadsorption was not associated with a significant reduction in IL-6 levels or periprocedural mortality.…”

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

“…Cardiac surgery may activate of the complement system and the immune system induced by surgical trauma, CPB, artificial surfaces and ischemia-reperfusion injury, which might further lead to systemic inflammatory response syndrome (SIRS) [17,18]. In 2017, a retrospective cohort study enrolling 28,513 patients found that the overall prevalence of postoperative SIRS within the first 24 h after cardiac surgery was as high as 58.7% [19].…”

“…In contrast, another pilot randomized controlled trial enrolling 30 patients undergoing elective cardiac surgery showed that CytoSorb® hemoadsorption during CPB was not associated with a reduction in both pro-and anti-inflammatory cytokines [38]. More recently, Daniela et al performed a retrospective study with 56 participants to investigate whether the use of CytoSorb® has an effect on IL-6 levels in patients undergoing cardiac surgery [17]. The results showed that IL-6 peaked on the first postoperative day in both the Cytosorb® and control groups (Cytosorb®: 775.3 ± 838.4 vs. control: 855.5 ± 1,052.9 pg/ml) and that intraoperative CytoSorb® hemoadsorption was not associated with a significant reduction in IL-6 levels or periprocedural mortality.…”