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Crit Care. 2019 Sep 18;23(1):317. doi: 10.1186/s13054-019-2588-1.

Hemoadsorption with CytoSorb shows a decreased observed versus expected 28-day all-cause mortality in ICU patients with septic shock: a propensity-score-weighted retrospective study.

Author information

1
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 15, Building NA-6, 3015, CE, Rotterdam, The Netherlands. w.p.brouwer@erasmusmc.nl.
2
Department of Internal Medicine, Maasstad Ziekenhuis, Rotterdam, The Netherlands. w.p.brouwer@erasmusmc.nl.
3
Department of Intensive Care Medicine, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
4
Science board, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
5
Department of Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Abstract

BACKGROUND AND AIMS:

Innovative treatment modalities have not yet shown a clinical benefit in patients with septic shock. To reduce severe cytokinaemia, CytoSorb as an add-on to continuous renal replacement therapy (CRRT) showed promising results in case reports. However, there are no clinical trials investigating outcomes.

METHODS:

In this investigator-initiated retrospective study, patients with septic shock were treated with CRRT + CytoSorb (n = 67) or CRRT alone (n = 49). The primary outcome was the 28-day all-cause mortality rate. Patients were weighted by stabilized inverse probability of treatment weights (sIPTW) to overcome differences in baseline characteristics.

RESULTS:

At the start of therapy, CytoSorb-treated patients had higher lactate levels (p < 0.001), lower mean arterial pressure (p = 0.007) and higher levels of noradrenaline (p < 0.001) compared to the CRRT group. For CytoSorb, the mean predicted mortality rate based on a SOFA of 13.8 (n = 67) was 75% (95%CI 71-79%), while the actual 28-day mortality rate was 48% (mean difference - 27%, 95%CI - 38 to - 15%, p < 0.001). For CRRT, based on a SOFA of 12.8 (n = 49), the mean predicted versus observed mortality was 68% versus 51% (mean difference - 16.9% [95%CI - 32.6 to - 1.2%, p = 0.035]). By sIPTW analysis, patients treated with CytoSorb had a significantly lower 28-day mortality rate compared to CRRT alone (53% vs. 72%, respectively, p = 0.038). Independent predictors of 28-day mortality in the CytoSorb group were the presence of pneumosepsis (adjusted odds ratio [aOR] 5.47, p = 0.029), higher levels of lactate at the start of CytoSorb (aOR 1.15, p = 0.031) and older age (aOR per 10 years 1.67, p = 0.034).

CONCLUSIONS:

CytoSorb was associated with a decreased observed versus expected 28-day all-cause mortality. By IPTW analysis, intervention with CytoSorb may be associated with a decreased all-cause mortality at 28 days compared to CRRT alone.

KEYWORDS:

Cytosorb; Cytosorbent; Hemofiltration; Mortality; Outcome; Sepsis; Septic shock; Treatment

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