Case study of 8 patients with multiple organ failure treated additionally with CytoSorbents haemadsorp- tion as adjunctive therapy in septic shock and severe SIRS in cardiac failure

Kogelmann K, Drüner M, Jarczak D
Department of Anaesthesiology, Hospital Emden, Germany Infection. 2015 Aug;43 Suppl 1:1-73. Abstract No. 58

Summary:

In this case series the authors aimed to investigate the effectiveness of CytoSorb treatment in 8 patients with sepsis/SIRS and multiple organ failure. They found a pronounced decrease in catecholamine demand and a distinct tendency in decrease of blood lactate levels during the treatment period and within 72 hours after CytoSorb therapy. However, no significant changes for SOFA-Score nor SAPS II-Score were detected. Importantly, compared with overall survival of about 45 % in severe sepsis including septic shock the authors could find a survival of 62.5 % in these patients. Treatment with CytoSorb was safe and without any noticed side effects.

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Patients, pre-treatment and indication for CytoSorb treatment

  • Seven patients with septic multiple organ failure and one patient with severe SIRS and MOF in cardiac failure treated additionally with CytoSorb as adjunctive therapy in septic shock
  • The infectious focus was abdominal (four patients) and pneumonic (three patients), one patient was without any infection
  • Initial therapy of these patients followed the Surviving Sepsis guidelines and focused on adequate volume therapy, differentiated catecho- lamine therapy (administering norepinephrine to achieve a mean arterial pressure of 60 mmHg), administering antibiotics not later than 1 hour after detection of septic shock and lung-protective ventilation
  • If there was no decline of catecholamine demand even after an additional corticoid treatment for 24 hours, CytoSorb therapy was initiated
  • Indication for hemadsorption therapy further included: at least two-organ failure with APACHE-2 Score higher than 25, no decline in requirement of norepinephrine despite adequate conventional therapy over a 24 hours period as well as the need for renal replacement therapy

Treatment

  • Duration of therapy with CytoSorb was predefined to be between 24 and 72 hours
  • Adsorber was changed every 24 hours

Measurements

  • Patient characteristics: sex, age
  • APACHE-2 score, ventilator days, length of stay (ICU and in-hospital) and survival
  • Before, during and after CytoSorb treatment
    – SAPS II-Score, SOFA-Score, MAP, requirement of norepinephrine, blood lactate level
  • Demand of norepinephrine (μg/h vs. mmHg MAP) during therapy

Results

  • Five patients were treated over a 72-h period, three patients for 48 h
  • Only marginal differences in SAPS II and SOFA- Score:
    – SAPS II-Score at start 51.1 ± 11.74, at the end: 38.6 ± 9.7
    – SOFA-Score at start 11.1 ± 2.85; at the end 9.75 ± 2.2
  • Slightly decreased blood lactate [mg/dl]
    – At start 29.2 ± 17.2, at the end: 13.9 ± 7.3
  • Huge impact on need for catecholamines with respect to the demand of norepinephrine [μg/h] vs. the thereby achieved MAP [mmHg]
    – At start: 52.7 ± 26.9;
    at the end: 3.6 ± 4.7 [μg/h * mmHg]
  • Compared with overall expected survival of about 45 % in severe sepsis including septic shock the authors could find a survival of 62.5 % in these patients

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CONCLUSIONS

  • Indication for CytoSorb therapy in this case series is comparable to former indication
    for activated recombinant human Protein C (drotegocin alfa activated): at least 2-organ failure with APACHE-2 score higher than 25, no decline in requirement of norepinephrine despite adequate conventional therapy over a 24 hours period
  • Treatment with CytoSorb in these 8 patients was safe and without any noticed side effects
  • The major effect seen was a pronounced decrease in catecholamine demand
  • Compared with overall expected survival of about 45 % in severe sepsis including septic shock the authors could find a survival of 62.5 % in these patients
  • Whether other patients could profit from this adjunctive treatment is uncertain and should be investigated