Experience with hemoadsorption (CytoSorb) in the management of septic shock patients.

Background: Cytokines and inflammatory mediators are the hallmarks of sepsis. Extracorporeal cytokine hemoadsorption devices are the newer clinical support system to overcome the cytokine storm during sepsis.

Aim: To retrospectively evaluate the clinical outcomes of patients admitted in intensive care unit with septic shock with different etiologies.

Methods: The laboratory parameters including biomarkers such as procalcitonin, serum lactate and C-reactive protein; and the hemodynamic parameters; mean arterial pressure, vasopressor doses, sepsis scores, cytokine levels and other vital parameters were evaluated. We evaluated these outcomes among survivors and non-survivors.

Results: Of 100 patients evaluated, 40 patients survived. Post treatment, the vasopressors dosage remarkably decreased though it was not statistically different; 34.15% ( = 0.0816) for epinephrine, 20.5 % for norepinephrine ( = 0.3099) and 51% ( = 0.0678) for vasopressin. In the survivor group, a remarkable reduction of biomarkers levels; procalcitonin (65%, = 0.5859), C-reactive protein (27%, = 0.659), serum lactate (27%, = 0.0159) and bilirubin (43.11%; = 0.0565) were observed from baseline after CytoSorb therapy. A significant reduction in inflammatory markers; interleukin 6 and interleukin 10; (87% and 92%, < 0.0001) and in tumour necrosis factor (24%, = 0.0003) was also seen. Overall, 28 (28%) patients who were given CytoSorb therapy less than 48 h after onset of septic shock survived and the maximum duration of stay for 70% of these patients in intensive care unit was less than 15 d.

Conclusion: CytoSorb is a safe and well tolerated rescue therapy option in patients with septic shock. However, early (preferably within < 48 h after onset of septic shock) initiation could result in better clinical outcomes. Further randomized trials are needed to define the potential benefits of this new treatment modality.