Multicentered prospective investigator initiated study to evaluate the clinical outcomes with extracorporeal cytokine adsorption device (CytoSorb®) in patients with sepsis and septic shock  

作　　者：Rajib Paul Prachee Sathe Senthil Kumar Shiva Prasad Ma Aleem Prashant Sakhalvalkar 

机构地区：[1]Department of Internal Medicine and Critical Care,Apollo Health City,Hyderabad 500033,India [2]Department of Critical Care Medicine,Ruby Hall Clinic,Pune 411001,India [3]Department of Critical Care Medicine,Apollo Hospital,Chennai 600006,India [4]Department of Anesthesiology and Critical Care,Narayana Institute of Cardiac Sciences,Bangaluru 560099,India

出　　处：《World Journal of Critical Care Medicine》2021年第1期22-34,共13页世界重症医学杂志

摘　　要：BACKGROUND Sepsis is a severe clinical syndrome related to the host response to infection.The severity of infections is due to an activation cascade that will lead to an auto amplifying cytokine production:The cytokine storm.Hemoadsorption by CytoSorb®therapy is a new technology that helps to address the cytokine storm and to regain control over various inflammatory conditions.AIM To evaluate prospectively CytoSorb®therapy used as an adjunctive therapy along with standard of care in septic patients admitted to intensive care unit(ICU).METHODS This was a prospective,real time,investigator initiated,observational multicenter study conducted in patients admitted to the ICU with sepsis and septic shock.The improvement of mean arterial pressure and reduction of vasopressor needs were evaluated as primary outcome.The change in laboratory parameters,sepsis scores[acute physiology and chronic health evaluation(APACHE II)and sequential organ failure assessment(SOFA)]and vital parameters were considered as secondary outcome.The outcomes were also evaluated in the survivor and nonsurvivor group.Descriptive statistics were used;a P value<0.05 was considered RESULTS Overall,45 patients aged≥18 and≤80 years were included;the majority were men(n=31;69.0%),with mean age 47.16±14.11 years.Post CytoSorb®therapy,26 patients survived and 3 patients were lost to follow-up.In the survivor group,the percentage dose reduction in vasopressor was norepinephrine(51.4%),epinephrine(69.4%)and vasopressin(13.9%).A reduction in interleukin-6 levels(52.3%)was observed in the survivor group.Platelet count improved to 30.1%(P=0.2938),and total lung capacity count significantly reduced by 33%(P<0.0001).Serum creatinine and serum lactate were reduced by 33.3%(P=0.0190)and 39.4%(P=0.0120),respectively.The mean APACHE II score was 25.46±2.91 and SOFA scores was 12.90±4.02 before initiation of CytoSorb®therapy,and they were reduced significantly post therapy(APACHE II 20.1±2.47;P<0.0001 and SOFA 9.04±3.00;P=0.0003)in the survivor group.Th

关 键 词：Acute physiology and chronic health evaluation score HEMADSORPTION SEPSIS Sequential organ failure assessment score VASOPRESSOR 

分 类 号：R515.3[医药卫生—内科学] R459.7[医药卫生—临床医学]