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

doi:10.5492/wjccm.v9.i1.1

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Jan 31, 2020 (publication date) through Aug 23, 2024

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World Journal of Critical Care Medicine

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2220-3141

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Crit Care Med. Jan 31, 2020; 9(1): 1-12
Published online Jan 31, 2020. doi: 10.5492/wjccm.v9.i1.1

Table 1 Baseline characteristics of all the patients, survivors and non-survivors before initiating the therapy (mean ± SD)

Baseline characteristics	Survivors (n = 40)	Non-survivors (n = 60)	P value (survivors vs non-survivors)
Age (yr)	51.3 ± 16.66	53.66 ± 16.47	0.4864
Urine output (mL/d)	551.13 ± 524.60	666.48 ± 595.25	0.3224
MAP (mmHg)	62.82 ± 9.73	66.31 ± 9.48	0.0774
GCS	6.26 ± 3.67	6.12 ± 4.56	0.8715
APACHE-II	24.6 ± 7.32	27.61 ± 9.29	0.0881
SOFA	12.3 ± 3.17	15.05 ± 3.35	0.0001
Leucocytes (cells/mm³)	15.60 ± 8.56	21.40 ± 26.17	0.1794
Platelets (cells/mm³)	123.95 ± 51.42	110.53 ± 50.18	0.1976
BUN	58.45 ± 36.94	108.55 ± 92.10	0.0015
SGOT(U/L)	1135.74 ± 2206.67	616.25 ± 1353.71	0.1477
SGPT(U/L)	504.63 ± 876.89	540.93 ± 1216.70	0.8712
S. Creatinine (mg/dL)	2.73 ± 1.86	7.01 ± 23.41	0.2521
S. Lactate (mg/dL)	3.71 ± 2.30	4.18 ± 3.23	0.3812
PaCO₂	38.46 ± 14.51	40.89 ± 12.20	0.3682
PaO₂	96.78 ± 41.42	84.50 ± 48.56	0.1920
FiO₂	49.32 ± 18.71	69.15 ± 67.74	0.0744

MAP: Mean arterial pressure; GCS: Glasgow coma scale; APACHE: Acute physiology and chronic health evaluation; SOFA: Sequential organ failure assessment; BUN: Blood urea nitrogen; SGOT: Serum glutamic oxaloacetic transaminase; SGPT: Serum glutamic pyruvic transaminase.

Table 2 CytoSorb scores and number of Cytosorb^® devices used (survivor vs non-survivor group)

CS score	Survivor (n)	CS score (n, number of devices used)	Non-survivor (n)	CS score (n, number of devices used)
< 8	0	-	0	-
8-13	35	10 (n = 1, 1)	21	11 (n = 1, 1)
		11 (n = 7, 1)		12 (n = 6, 1)
		12 (n = 19; 18 = 1, 1 = 2)		13 (n = 14; 13 = 1, 1 = 3)
		13 (n = 8; 1 = 1, 3 = 2, 1 = 3)
> 13	5	14 (n = 5; 1 = 1, 3 = 2, 1 = 3)	39	14 (n = 27; 21 = 1, 6 = 2)
> 13	5		39	15 (n = 12; 11 = 1, 4 = 2)

CS: CytoSorb.

Table 3 Change in laboratory and vital parameters (survivors)

Parameters	Pre CytoSorb^® therapy	Post CytoSorb^® therapy	Percentage change	P value
Urine output (mL/d)	551.13 ± 524.60	862.88 ± 682.46	56.56	0.0247^a
CRP (mg/dL)	165.68 ± 169.26	120.33 ± 63.72	-27.4	0.6590
PCT (ng/dL)	121.56 ± 421.20	42.81 ± 69.89	-65	0.5859
MAP (mm/Hg)	62.82 ± 9.73	68.23 ± 7.50	8.6	0.1805
GCS	6.26 ± 3.67	8.05 ± 3.92	22.36	0.0417^c
Leucocytes (cells/mm³)	15.60 ± 8.56	13.09 ± 6.71	-16.02	0.1484
Platelets (cells/mm³)	123.95 ± 51.42	118.75 ± 48.33	-4.2	0.6425
S. Creatinine (mg/dL)	2.73 ± 1.86	2.27 ± 1.31	-16.84	0.2048
S. Lactate (mmol/L)	3.71 ± 2.30	2.28 ± 0.89	-26.66	0.0159^a
SGOT (U/L)	1135.74 ± 2206.67	1078.92 ± 1890.45	-5.00	0.9222
SGPT (U/L)	504.63 ± 876.89	316.59 ± 645.41	-37.26	0.3796
BUN	58.45 ± 36.94	56.67 ± 28.24	-3.05	0.8266
Bilirubin (mg/dL)	3.27 ± 2.67	1.86 ± 1.51	-43.11	0.0565^a
Sodium (mmol/L)	136.59 ± 24.49	136.31 ± 24.22	-0.20	0.9615
Potassium (mmol/L)	4.22 ± 0.65	3.75 ± 0.56	-11.14	< 0.0001^a
Albumin (g/L)	2.64 ± 0.58	2.65 ± 0.62	0.38	0.9412
Arterial pH	7.33 ± 0.13	7.37 ± 0.13	0.55	0.1727
Bicarbonate	20.32 ± 4.05	22.825 ± 3.86	12.35	0.0060^a
PaO₂	96.78 ± 41.42	85.88 ± 27.89	-11.26	0.1714
PaCO₂	38.46 ± 14.51	38.36 ± 14.53	-0.26	0.9755
FiO₂	49.32 ± 18.71	41.95 ± 13.71	-14.94	0.0550

^aP < 0.05, significant decrease;

^cP < 0.05, significant rise. All values are defined as mean ± SD. Hb: Haemoglobin; SGOT: Serum glutamic oxaloacetic transaminase; SGPT: Serum glutamic-pyruvic transaminase; BUN: Blood urea nitrogen; CRP: C-reactive protein; PCT: Procalcitonin test; MAP: Meanarterial pressure; GCS: Glasgow Coma Scale.

Table 4 Change in laboratory and vital parameters (non-survivor group)

Parameters	Pre CytoSorb^® therapy	Post CytoSorb^® therapy	Percentage change	P value
Urine output (mL/d)	666.48 ± 595.25	493.85 ± 433.11	-25.90	0.0718
CRP (mg/dL)	1175.22 ± 126.60	-	-	-
PCT (ng/dL)	24.91 ± 24.51	48.97 ± 57.57	96.58	0.0766
MAP (mm/Hg)	66.13 ± 9.485	64.31 ± 10.87	-2.75	0.3304
GCS	6.12 ± 4.56	4.27 ± 2.91	-30.23	0.0129^a
Leucocytes (cells/mm³)	21.40 ± 26.17	20.25 ± 18.25	-5.34	0.7327
Platelets (cells/mm³)	110.53 ± 50.18	99.67 ± 47.81	-9.83	0.2273
S. Creatinine (mg/dL)	7.01 ± 23.41	5.27 ± 23.19	-24.82	0.0088^a
S. Lactate (mmol/L)	4.18 ± 3.23	5.05 ± 3.75	17.2	0.1759
SGOT (U/L)	616.25 ± 1353.71	1418.14 ± 2068	130.12	0.0693
SGPT (U/L)	540.93 ± 1216.70	577.38 ± 945.94	6.74	0.9048
BUN	108.55 ± 92.10	95.02 ± 84.83	-12.46	0.4362
Bilirubin (mg/dL)	5.15 ± 14.19	3.84 ± 4.09	-25.44	0.6543
Sodium (mmol/L)	133.79 ± 26.22	139.51 ± 7.32	4.28	0.1244
Potassium (mmol/L)	4.43 ± 1.03	4.15 ± 1.03	-6.32	0.1392
Albumin (g/L)	3.03 ± 1.07	2.85 ± 0.80	-5.94	0.2988
Arterial pH	7.28 ± 0.14	7.22 ± 0.18	-0.82	0.0438
Bicarbonate	24.52 ± 24.21	22.16 ± 22.19	-9.62	0.6560
PaO₂	84.50 ± 48.56	90.42 ± 51.14	7.01	0.5256
PaCO₂	40.89 ± 12.20	45.05 ± 33.71	10.17	0.3760
FiO₂	69.15 ± 67.74	62.6 ± 28.61	-9.47	0.5016

^aP < 0.05, significant decrease, all values are defined as mean ± SD. Hb: Haemoglobin; SGOT: Serum glutamic oxaloacetic transaminase; SGPT: Serum glutamic-pyruvic transaminase; BUN: Blood urea nitrogen; CRP: C-reactive protein; PCT: Procalcitonin test; MAP: Mean arterial pressure; GCS: Glasgow Coma Scale.

Table 5 Cytokine assay (survivor group) (mean ± SD)

Cytokine (pg)	Pre CytoSorb^® therapy	Post CytoSorb^® therapy	Percentage decrease	P value
IL-1	3.82 ± 3.12	2.97 ± 2.99	22.25	0.2172
IL-6	1962.04 ± 229.09	254.09 ± 223.62	87	< 0.0001^a
IL-10	293.75 ± 176.28	124.33 ± 73.61	91.7	< 0.0001^a
TNF	20.82 ± 5.74	15.86 ± 6.11	23.82	0.0003^a

^aP < 0.05, significant value. IL: Interleukin; TNF: Tumour necrosis factor.

Table 6 Cytokine assay (non-survivor group) (mean ± SD)

Cytokine (pg)	Pre CytoSorb^® therapy	Post CytoSorb^® therapy	Percentage change	P value
IL-1	5.52 ± 2.59	5.79 ± 2.55	4.89	0.7364
IL-6	2273.51 ± 1212.82	2638.24 ± 1518.26	16.04	0.1486
IL-10	296.00 ± 146.4	295.67 ± 112.00	-0.111	0.9894
TNF	19.43 ± 6.07	20.40 ± 6.26	5.00	0.3914

IL: Interleukin; TNF: Tumour necrosis factor.

Citation: Mehta Y, Mehta C, Kumar A, George JV, Gupta A, Nanda S, Kochhar G, Raizada A. Experience with hemoadsorption (CytoSorb^®) in the management of septic shock patients. World J Crit Care Med 2020; 9(1): 1-12
URL: https://www.wjgnet.com/2220-3141/full/v9/i1/1.htm
DOI: https://dx.doi.org/10.5492/wjccm.v9.i1.1