Septic shock and severe sepsis

Sepsis is the overzealous immune response to a serious infection, such as pneumonia, a urinary tract infection, a ruptured appendix, cholecystitis, influenza, or cellulitis.  Sepsis with organ dysfunction is termed severe sepsis and has an expected mortality of 20-30%, while septic shock requiring vasopressors has an expected mortality of 40% or more. With the exception of antibiotics to treat the infection, and supportive care treatment, there are no specific therapies approved to treat the deadly inflammatory response.  Because of this, sepsis remains one of the most significant challenges in medicine and is a top-ten cause of death despite the availability of the best medical care including antibiotics.

“Sepsis is a complex systemic inflammatory response that affects the entire organism, tissues, organs and thus all vital functions. If sepsis is not recognized and treated in time, this will inevitably lead to septic shock, multiple organ failure and to death. One third to one half of all patients do not survive sepsis.”  (source: www.world-sepsis-day.org)

“Sepsis causes more deaths each year than breast cancer, prostate cancer and HIV / AIDS together. Worldwide 20 – 30 million cases are estimated per year. It can be assumed that sepsis is responsible for the majority of deaths associated with HIV / AIDS, malaria, pneumonia and other infections, regardless of whether these were acquired at home, in hospital or after injury.”  (source: www.world-sepsis-day.org).

In Germany alone, approximately 150,000 people develop sepsis each year, and approximately 56,000 people die (37%) despite maximal treatment. With 162 deaths per day, sepsis is the third highest cause of death in Germany, next to coronary heart disease and myocardial infarctions (1).

Sepsis is also costly to treat. In the United States, where 1 million people each year develop sepsis, hospital-related treatment costs in 2008 were estimated at $14.6 billion with an annual growth rate of around 10% (2). In Germany, the average hospital costs per sepsis patient amount to about 55,000 Euros (3). U.S. costs are similar at approximately $45,000 – $65,000 per treated patient. Further costs outside the hospital are not even considered here. And if patients survive, they have
twice the risk of dying in the next 5 years compared to other hospital patients. They also suffer from physical, cognitive and psychological late complications.

Unlike other therapies that have been tried in the past, CytoSorb therapy attacks severe sepsis and septic shock from many sides, with the goals of:
1) Pro-inflammatory cytokine and mediator reduction

  • Modulation of the SIRS response and reduced de novo cytokine production
  • Improved hemodynamics (macro- and microcirculation)
  • Reduced capillary leak, with improved tissue perfusion, lung function and fluid balance
  • Prevention of inflammatory mediator-induced tissue damage
  • Removal of other DAMPs and PAMPs that can drive inflammation

 

2) Anti-inflammatory cytokine reduction

  • Mitigation of “immune paralysis“ and reduced risk of nosocomial infections

 

3) Bacterial exotoxin reduction

  • A unique and powerful strategy to deal with a wide range of bacterial, viral and fungal toxins that greatly increase pathogen virulence, organ injury, and risk of death in sepsis

 

4) Retargeting the cellular immune response to the focus of infection

  • Prevention of cell-mediated injury to otherwise healthy organs
  • Improved source control and targeting of immune cells to the site of infection

 

You can read more on the currently available data and ongoing studies in the area “The Studies”.

 


References 

(1) Epidemiology of sepsis in Germany: results from a national prospective multicenter study.
Engel C, Brunkhorst FM, Bone HG, Brunkhorst R, Gerlach H, Grond S, Gruendling M, Huhle G, Jaschinski U, John S, Mayer K, Oppert M, Olthoff D, Quintel M, Ragaller M, Rossaint R, Stuber F, Weiler N, Welte T, Bogatsch H, Hartog C, Loeffler M, Reinhart K.
Intensive Care Med. 2007 Apr;33(4):606-18.

(2) Inpatient care for septicemia or sepsis: a challenge for patients and hospitals.
Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A.
NCHS Data Brief. 2011 Jun;(62):1-8.

(3) Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery: a large, nationwide sample.
Bateman BT, Schmidt U, Berman MF, Bittner EA
Anesthesiology. 2010 Apr;112(4):917-25.