Cargando…

Experience with hemoadsorption (CytoSorb(®)) in the management of septic shock patients

BACKGROUND: Cytokines and inflammatory mediators are the hallmarks of sepsis. Extracorporeal cytokine hemoadsorption devices are the newer clinical support system to overcome the cytokine storm during sepsis. AIM: To retrospectively evaluate the clinical outcomes of patients admitted in intensive ca...

Descripción completa

Detalles Bibliográficos
Autores principales: Mehta, Yatin, Mehta, Chitra, Kumar, Ashish, George, Joby Varghese, Gupta, Aditi, Nanda, Saurabh, Kochhar, Gourav, Raizada, Arun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031623/
https://www.ncbi.nlm.nih.gov/pubmed/32104647
http://dx.doi.org/10.5492/wjccm.v9.i1.1
_version_ 1783499415636410368
author Mehta, Yatin
Mehta, Chitra
Kumar, Ashish
George, Joby Varghese
Gupta, Aditi
Nanda, Saurabh
Kochhar, Gourav
Raizada, Arun
author_facet Mehta, Yatin
Mehta, Chitra
Kumar, Ashish
George, Joby Varghese
Gupta, Aditi
Nanda, Saurabh
Kochhar, Gourav
Raizada, Arun
author_sort Mehta, Yatin
collection PubMed
description BACKGROUND: Cytokines and inflammatory mediators are the hallmarks of sepsis. Extracorporeal cytokine hemoadsorption devices are the newer clinical support system to overcome the cytokine storm during sepsis. AIM: To retrospectively evaluate the clinical outcomes of patients admitted in intensive care unit with septic shock with different etiologies. METHODS: The laboratory parameters including biomarkers such as procalcitonin, serum lactate and C-reactive protein; and the hemodynamic parameters; mean arterial pressure, vasopressor doses, sepsis scores, cytokine levels and other vital parameters were evaluated. We evaluated these outcomes among survivors and non-survivors. RESULTS: Of 100 patients evaluated, 40 patients survived. Post treatment, the vasopressors dosage remarkably decreased though it was not statistically different; 34.15% (P = 0.0816) for epinephrine, 20.5 % for norepinephrine (P = 0.3099) and 51% (P = 0.0678) for vasopressin. In the survivor group, a remarkable reduction of biomarkers levels; procalcitonin (65%, P = 0.5859), C-reactive protein (27%, P = 0.659), serum lactate (27%, P = 0.0159) and bilirubin (43.11%; P = 0.0565) were observed from baseline after CytoSorb(®) therapy. A significant reduction in inflammatory markers; interleukin 6 and interleukin 10; (87% and 92%, P < 0.0001) and in tumour necrosis factor (24%, P = 0.0003) was also seen. Overall, 28 (28%) patients who were given CytoSorb(®) therapy less than 48 h after onset of septic shock survived and the maximum duration of stay for 70% of these patients in intensive care unit was less than 15 d. CONCLUSION: CytoSorb(®) is a safe and well tolerated rescue therapy option in patients with septic shock. However, early (preferably within < 48 h after onset of septic shock) initiation could result in better clinical outcomes. Further randomized trials are needed to define the potential benefits of this new treatment modality.
format Online
Article
Text
id pubmed-7031623
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Baishideng Publishing Group Inc
record_format MEDLINE/PubMed
spelling pubmed-70316232020-02-26 Experience with hemoadsorption (CytoSorb(®)) in the management of septic shock patients Mehta, Yatin Mehta, Chitra Kumar, Ashish George, Joby Varghese Gupta, Aditi Nanda, Saurabh Kochhar, Gourav Raizada, Arun World J Crit Care Med Observational Study BACKGROUND: Cytokines and inflammatory mediators are the hallmarks of sepsis. Extracorporeal cytokine hemoadsorption devices are the newer clinical support system to overcome the cytokine storm during sepsis. AIM: To retrospectively evaluate the clinical outcomes of patients admitted in intensive care unit with septic shock with different etiologies. METHODS: The laboratory parameters including biomarkers such as procalcitonin, serum lactate and C-reactive protein; and the hemodynamic parameters; mean arterial pressure, vasopressor doses, sepsis scores, cytokine levels and other vital parameters were evaluated. We evaluated these outcomes among survivors and non-survivors. RESULTS: Of 100 patients evaluated, 40 patients survived. Post treatment, the vasopressors dosage remarkably decreased though it was not statistically different; 34.15% (P = 0.0816) for epinephrine, 20.5 % for norepinephrine (P = 0.3099) and 51% (P = 0.0678) for vasopressin. In the survivor group, a remarkable reduction of biomarkers levels; procalcitonin (65%, P = 0.5859), C-reactive protein (27%, P = 0.659), serum lactate (27%, P = 0.0159) and bilirubin (43.11%; P = 0.0565) were observed from baseline after CytoSorb(®) therapy. A significant reduction in inflammatory markers; interleukin 6 and interleukin 10; (87% and 92%, P < 0.0001) and in tumour necrosis factor (24%, P = 0.0003) was also seen. Overall, 28 (28%) patients who were given CytoSorb(®) therapy less than 48 h after onset of septic shock survived and the maximum duration of stay for 70% of these patients in intensive care unit was less than 15 d. CONCLUSION: CytoSorb(®) is a safe and well tolerated rescue therapy option in patients with septic shock. However, early (preferably within < 48 h after onset of septic shock) initiation could result in better clinical outcomes. Further randomized trials are needed to define the potential benefits of this new treatment modality. Baishideng Publishing Group Inc 2020-01-31 /pmc/articles/PMC7031623/ /pubmed/32104647 http://dx.doi.org/10.5492/wjccm.v9.i1.1 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Observational Study
Mehta, Yatin
Mehta, Chitra
Kumar, Ashish
George, Joby Varghese
Gupta, Aditi
Nanda, Saurabh
Kochhar, Gourav
Raizada, Arun
Experience with hemoadsorption (CytoSorb(®)) in the management of septic shock patients
title Experience with hemoadsorption (CytoSorb(®)) in the management of septic shock patients
title_full Experience with hemoadsorption (CytoSorb(®)) in the management of septic shock patients
title_fullStr Experience with hemoadsorption (CytoSorb(®)) in the management of septic shock patients
title_full_unstemmed Experience with hemoadsorption (CytoSorb(®)) in the management of septic shock patients
title_short Experience with hemoadsorption (CytoSorb(®)) in the management of septic shock patients
title_sort experience with hemoadsorption (cytosorb(®)) in the management of septic shock patients
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031623/
https://www.ncbi.nlm.nih.gov/pubmed/32104647
http://dx.doi.org/10.5492/wjccm.v9.i1.1
work_keys_str_mv AT mehtayatin experiencewithhemoadsorptioncytosorbinthemanagementofsepticshockpatients
AT mehtachitra experiencewithhemoadsorptioncytosorbinthemanagementofsepticshockpatients
AT kumarashish experiencewithhemoadsorptioncytosorbinthemanagementofsepticshockpatients
AT georgejobyvarghese experiencewithhemoadsorptioncytosorbinthemanagementofsepticshockpatients
AT guptaaditi experiencewithhemoadsorptioncytosorbinthemanagementofsepticshockpatients
AT nandasaurabh experiencewithhemoadsorptioncytosorbinthemanagementofsepticshockpatients
AT kochhargourav experiencewithhemoadsorptioncytosorbinthemanagementofsepticshockpatients
AT raizadaarun experiencewithhemoadsorptioncytosorbinthemanagementofsepticshockpatients