Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jan 31, 2020; 9(1): 1-12
Published online Jan 31, 2020. doi: 10.5492/wjccm.v9.i1.1
Experience with hemoadsorption (CytoSorb®) in the management of septic shock patients
Yatin Mehta, Chitra Mehta, Ashish Kumar, Joby Varghese George, Aditi Gupta, Saurabh Nanda, Gourav Kochhar, Arun Raizada
Yatin Mehta, Chitra Mehta, Ashish Kumar, Joby Varghese George, Aditi Gupta, Saurabh Nanda, Gourav Kochhar, Arun Raizada, Medanta The Medicity, Gurgaon 122001, Haryana, India
Author contributions: Mehta Y, Mehta C, Kumar A and Raizada A contributed to study conception and design; George JV, Gupta A, Nanda S, and Kochhar G contributed to data acquisition, data analysis and interpretation, and writing of article; Mehta Y, Mehta C, and Kumar A contributed to editing, reviewing and final approval of article.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Institutional review board statement: this study was reviewed and approved by an institutional ethics committee.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: Yes, we have read the Strobe statement and prepared checklist and the manuscript accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yatin Mehta, FRCA, MD, MNAMS, Doctor, FAMS, FIACIA, FICCM, FIEE, Chairman, Institute of Critical Care and Anesthesiology, Medanta the Medicity, Sector 38, Gurgaon 122006, Haryana, India. yatin.mehta@medanta.org
Received: October 11, 2019
Peer-review started: October 11, 2019
First decision: November 1, 2019
Revised: December 23, 2019
Accepted: January 13, 2020
Article in press: January 13, 2020
Published online: January 31, 2020
ARTICLE HIGHLIGHTS
Research background

Sepsis is one of the world’s leading cause of death in the intensive care unit (ICU) and yet remains the most significant unmet medical need. Sepsis results due to complex interactive reactions between infecting microbe and the immune system of host. CytoSorb® is an European CE mark approved and ISO certified hemoadsorption device which helps in reducing cytokine storm in the blood. In this study, clinical outcomes were evaluated after the use CytoSorb® device as an adjuvant therapy in patients who were admitted in ICU with sepsis between 2016 and 2018.

Research motivation

Most of the patients with septic shock end up dying even though control of inflammation has been attempted through various means. CytoSorb® is an emerging extracorporeal hemadsorption device but there is a paucity of clinical evidence supporting its benefits and clinical outcomes after use. Previous individual studies have shown promising results after use of CytoSorb® therapy in patients with sepsis and septic shock. We used CytoSorb® in 100 patients admitted to ICU with sepsis a rescue therapy but had not analyzed the data to evaluate clinical outcomes in these patients. This study will serve as an important link to guide doctors about the usage of CytoSorb® and possible clinical outcomes. Further, this study will help answer an important question of when to start the CytoSorb® therapy after the onset of septic shock and how many devices are optimums for patients.

Research objectives

The objective of this study was to evaluate the clinical benefits of CytoSorb® therapy in critically ill patients admitted in ICU. We looked for the patients’ suitability for this therapy and determined the extent of improvement in laboratory and hemodynamic parameters post therapy with CytoSorb®. Future research should have the objective of a comparative study with a control group and a prospective randomized controlled trial should be performed to provide more evidence.

Research methods

A retrospective observational study was carried out over a period of 2 years. We used the CytoSorb® scoring (CS) system that was developed by group of clinicians for initiating CytoSorb® therapy on the basis of their practical experience for the evaluation of patients. The scoring system was derived from five parameters (hemodynamic, renal, respiratory, lab and sepsis scores), representing five different organ system which get affected in sepsis patients. At the end, final scores were calculated by adding all the individual organ system scores. We evaluated the vitals, laboratory and other parameters by observing the data pre and post CytoSorb® administration.

Research results

The survivor group had a decrease in total leucocyte count, serum creatinine, serum lactate and platelet count. In the non-survivor group, serum creatinine levels and other parameters did not improve. We also observed that there was a significant decrease in inflammatory markers in the survivor group. Another major observation is that 70% of those who received the CytoSorb® therapy within 48 h had better chances of survival.

Research conclusions

CytoSorb® score used in this study is a newly devised scoring system that can guide doctors about usage of CytoSorb® therapy. This study proposes that the CytoSorb® therapy should be recommended to the patients with scores between 8-13. For patients with CS between 10-14; dialysis in combination with one or more CytoSorb® device depending on their clinical outcomes should be followed. In summary, this study showed a reduction in the vasopressor dose, a significant reduction in cytokine levels, remarkable reduction in diagnostic markers such as PCT, CRP, bilirubin and serum lactate after the usage of CytoSorb® therapy. The new hypothesis that this study proposed is there is an improvement in MAP levels, vasopressor dose and other laboratory and clinical parameters when the CytoSorb® therapy is initiated early after onset of septic shock. We used a newly devised scoring system called CytoSorb® score that was derived from five parameters (hemodynamic, renal, respiratory, laboratory and sepsis scores), representing five different organ system which get affected in sepsis patients. Through this study, we reinforced that the CytoSorb® is a safe and well tolerated rescue therapy option in patients with severe septic shock.

Research perspectives

The lesson learnt from this study is that CytoSorb® therapy should be initiated early in critically ill patients with sepsis and septic shock. In the future, we should design randomized clinical studies that can compare the results with control population. The best method would be to use CS score to decide the usage of CytoSorb® therapy.