Effect of Cytosorb Coupled With Hemodialysis on Interleukin-6 and Hemodynamic Parameters in Patients With Systemic Inflammatory Response Sindrome: a Retrospective Cohort Study

Abstract Background. Systemic inflammatory response syndrome (SIRS) is a complex pathophysiologic response to several hostile stimuli. The excessive release of cytokines during SIRS often leads to a cytokine storm causing refractory hypotension and ultimately multiple organ failure with high mortality. Cytokine removal with hemoadsorption has emerged as a possible adjuvant therapy, but data on IL-6 reduction and clinical outcomes are scarce. We aimed to evaluate the effect of CytoSorb hemoadsorption on laboratory parameters and clinical outcomes in shocked patients with SIRS. Methods. We designed a retrospective analysis of all patients with SIRS treated with CytoSorb in intensive care units. Interleukin 6 (IL-6), hemodynamic parameters (mean arterial pressure – MAP and vasoactive inotropic score - VIS), pH and lactate levels at the beginning, after 6h, 12h, 24h and 48h of CytoSorb treatment were analyzed in the whole cohort and in a subgroup of patients with septic shock. Predicted and observed mortality rates were compared using Chi-squared test. Statistical significance was defined as p <0.05 and <0.012 in multiple comparisons where a Bonferroni correction was applied.Results. After screening 147 patients, we included 118 patients with various etiologies of SIRS (septic shock 69%, SIRS after cardiac arrest 16%, SIRS after acute pancreatitis 6%, other 9%). In all but one patient CytoSorb was coupled with renal replacement therapy. During the observed period of 48 hours, a statistically significant decrease in IL-6 levels, increase in pH, increase in MAP and decrease in VIS was observed already from 6h onward. Reduction of lactate levels became statistically significant at 48 hours. In a subgroup of patients with septic shock, the results were similar, and PCT levels did decreased after 24 hours. Observed ICU and in-hospital mortalities in the whole group were lower than predicted by SOFA (61% vs 79%, p=0.005) and APACHE II (64% vs 78%, p=0.031). There were no serious complications attributed to CytoSorb treatment.Conclusions. Hemoadsorption with CytoSorb used in patients with SIRS of different etiologies was associated with a rapid decrease in IL-6 and hemodynamic improvement, with improved observed vs. predicted survival. These results need to be confirmed in a randomized study.