Hemoadsorption in the critically ill-Final results of the International CytoSorb Registry

PLoS One. 2022 Oct 25;17(10):e0274315. doi: 10.1371/journal.pone.0274315. eCollection 2022.

Abstract

The aim of the current paper is to summarize the results of the International CytoSorb Registry. Data were collected on patients of the intensive care unit. The primary endpoint was actual in-hospital mortality compared to the mortality predicted by APACHE II score. The main secondary endpoints were SOFA scores, inflammatory biomarkers and overall evaluation of the general condition. 1434 patients were enrolled. Indications for hemoadsorption were sepsis/septic shock (N = 936); cardiac surgery perioperatively (N = 172); cardiac surgery postoperatively (N = 67) and "other" reasons (N = 259). APACHE-II-predicted mortality was 62.0±24.8%, whereas observed hospital mortality was 50.1%. Overall SOFA scores did not change but cardiovascular and pulmonary SOFA scores decreased by 0.4 [-0.5;-0.3] and -0.2 [-0.3;-0.2] points, respectively. Serum procalcitonin and C-reactive protein levels showed significant reduction: -15.4 [-19.6;-11.17] ng/mL; -17,52 [-70;44] mg/L, respectively. In the septic cohort PCT and IL-6 also showed significant reduction: -18.2 [-23.6;-12.8] ng/mL; -2.6 [-3.0;-2.2] pg/mL, respectively. Evaluation of the overall effect: minimal improvement (22%), much improvement (22%) and very much improvement (10%), no change observed (30%) and deterioration (4%). There was no significant difference in the primary outcome of mortality, but there were improvements in cardiovascular and pulmonary SOFA scores and a reduction in PCT, CRP and IL-6 levels. Trial registration: ClinicalTrials.gov Identifier: NCT02312024 (retrospectively registered).

MeSH terms

  • Biomarkers
  • C-Reactive Protein
  • Critical Illness / therapy
  • Humans
  • Interleukin-6
  • Procalcitonin
  • Prognosis
  • ROC Curve
  • Registries
  • Sepsis* / metabolism
  • Sepsis* / therapy
  • Shock, Septic*

Substances

  • Procalcitonin
  • C-Reactive Protein
  • Interleukin-6
  • Biomarkers

Associated data

  • ClinicalTrials.gov/NCT02312024

Grant support

The authors received no specific funding for this work. The funder provided support in the form of research material but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials. KT, KK, AF, FB and ZM received honoraria for lectures and consultations from CytoSorbents Europe (Berlin, Germany), ZM also functions as a medical director at CytoSorbents Europe (Berlin, Germany).