Hemoadsorption in the critically ill—Final results of the International CytoSorb Registry
Fatime Hawchar, Dana Tomescu, Karl Träger, Dominik Jóskowiak, Klaus Kogelmann, Jens Soukup, Singrun Friesecke, David Jacob, Jan Gummert, Andreas Faltlhauser, Filippo Aucella, Martijn van Tellingen, Manu L. N. G. Malbrain, Ralph Bogdanski, Günter Weiß, Andreas Herbrich, Stefan Utzolino, Axel Nierhaus, Andreas Baumann, Andreas Hartjes, Dietrich Henzler, E. V. Grigoryev, Harald Fritz, Friedhelm Bach, Stefan Schröder, A. Weyland, Udo Gottschaldt, Matthias Menzel, Olivier Zachariae, Radovan Novak, Jernej Berden, Hendrik Haake, Michael Quintel, Stephan Kloesel, Andreas Kortgen, Stephanie Susanne Stecher, Patricia Torti, Frieder Nestler, M. Nitsch, Detlef Olboeter, Philip Muck, Michael Findeisen, Diane Bitzinger, Jens Kraßler, Martin Benad, Martin Schott, Ulrike Schumacher, Zsolt Molnár, Frank M. Brunkhorst
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).