Sepsis and septic Schock
Sepsis is currently defined as a life-threatening organ dysfunction caused by an overreacting response of the immune system to infection (1). Focus is thus on the overreacting immune response of the body, which is responsible, in part, for serious clinical complications, resulting in high intensive care costs.
If the medical and therapeutic options could be expanded here by CytoSorb, this would be a welcome approach to tackling the big issues. Despite numerous efforts and various therapeutic approaches in the past decades, sepsis remains one of the most important challenges in medicine, especially in intensive care, and is one of the most frequent causes of death:
Patients who survive sepsis are twice as likely to die in the following 5 years compared to other hospital patients. They suffer from physical, cognitive and psychological sequelae.
In Germany, around 150,000 people develop sepsis each year, of which 56,300 die (2). Approximately 30-50% of patients die despite maximal therapy. With 162 deaths daily, sepsis after coronary heart disease and heart attack is the third biggest cause of death in Germany.
The treatment of sepsis consumes vast costs. Hospital-related treatment costs in the US in 2008 were estimated at $ 14.6 billion, with an annual growth rate of around 10% (3). In Germany, the average hospital costs per sepsis patient amount to approximately 55,000 euros (4); with the additional costs of treatments outside the hospital not even taken into considered.
The goals of CytoSorb therapy in septic shock are:
Rapid and sustained reduction of cytokine burden and thus attenuation of excess immune response with subsequent:
- Improvement in hemodynamics (macro- and micro-circulation)
- Reduction of capillary leakage and improvement in fluid balance
- Prevention of mediator-induced tissue damage
- Reduced production of new inflammatory mediators
- Reorientation of the cellular immune response to the focus
- Removal of additional harmful substances that are either toxic or whose accumulation can induce further complications, such as – bacterial enterotoxins – myoglobin in rhabdomyolysis – bile acids and bilirubin in septic cholestasis and or liver failure
Currently available data and ongoing studies can be found in the section “The Studies.
(1) The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
Mervyn Singer, MD, FRCP; Clifford S. Deutschman, MD, MS; Christopher Warren Seymour, MD, MSc; Manu Shankar-Hari, MSc, MD, FFICM; Djillali Annane, MD, PhD; Michael Bauer, MD; Rinaldo Bellomo, MD; Gordon R. Bernard, MD; Jean-Daniel Chiche, MD, PhD; Craig M. Coopersmith, MD; Richard S. Hotchkiss, MD; Mitchell M. Levy, MD; John C. Marshall, MD; Greg S. Martin, MD, MSc; Steven M. Opal, MD; Gordon D. Rubenfeld, MD, MS; Tom van der Poll, MD, PhD; Jean-Louis Vincent, MD, PhD; Derek C. Angus, MD, MPH JAMA. 2016;315(8):801-810
(2) 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.
(3) 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.
(4) 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.