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Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study

Abstract

Sepsis is the most common cause of death in medical intensive care units (ICU). If sepsis progresses to refractory septic shock, mortality may reach 90–100% despite optimum current therapy. Extracorporeal cytokine adsorption in addition to regular therapy was studied prospectively in refractory septic shock patients on a medical ICU. Refractory shock was defined as increasing vasopressor dose required to maintain mean arterial blood pressure above 65 mmHg or increasing lactate levels despite protocol-guided shock therapy for 6 h. We analysed noradrenaline requirements after 6 and 12 h (primary endpoint), lactate clearance after 6 and 12 h, SOFA-scores in the first days and achievement of shock reversal (i.e., normalization of lactate concentrations and sustained discontinuation of vasopressors; secondary endpoints). Twenty consecutive patients with refractory septic shock were included; CytoSorb® treatment was started after 7.8 ± 3.7 h of shock therapy. Following the initiation of adsorption therapy, noradrenaline dose could be significantly reduced after 6 (−0.4 µg/kg/min; p = 0.03) and 12 h (−0.6 µg/kg/min; p = 0.001). Lactate clearance improved significantly. SOFA-scores on day 0, 1 and 2 remained unchanged. Shock reversal was achieved in 13 (65%) patients; 28-day survival was 45%. In severe septic shock unresponsive to standard treatment, haemodynamic stabilization was achieved using cytokine adsorption therapy, resulting in shock reversal in two-thirds of these patients. The study was registered in the German Register for Clinical Trials (DRKS) No. 00005149.

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Acknowledgements

We are indebted to the nursing staff of our intensive care unit and the staff of the dialysis department for their excellent work. We thank Mr. Sebastian Maletzki for his help with the data collection and data presentation.

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Correspondence to Sigrun Friesecke.

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Ethics approval and consent to participate

This study was approved by the institutional ethics committee of the Ernst Moritz Arndt University Greifswald (No. BB 048/13). Written informed consent was obtained from patients or their legal representatives.

Conflict of interest

CytoSorbents Europe supplied the hemadsorption cartridges used in this study free of charge. SF has received lecture honoraria, AN has received lecture honoraria and travel reimbursements from CytoSorbents Europe. SSS, SG and SBF declare no conflicts of interest.

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10047_2017_967_MOESM1_ESM.doc

Fig. 3: Interleukin 6 levels before and during treatment with CytoSorb®. Values are shown as mean with 95% CIs in logarithmic scale. Mean and 95%CI values of log-transformed outcomes were accordingly back-transformed to the original scale. Difference vs. “d0” (before CytoSorb® start): ** p < 0.01, *** p < 0.001 (DOC 42 kb)

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Friesecke, S., Stecher, SS., Gross, S. et al. Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study. J Artif Organs 20, 252–259 (2017). https://doi.org/10.1007/s10047-017-0967-4

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Keywords

  • Septic shock therapy
  • Refractory septic shock
  • Interleukin 6
  • Blood purification
  • CytoSorb®