First Evaluation of a New Dynamic Scoring System Intended to Support Prescription of Adjuvant CytoSorb Hemoadsorption Therapy in Patients with Septic Shock

Abstract

Introduction: Despite advances in critical care medicine, adjunctive approaches in sepsis therapy have failed to prove their efficacy. Notwithstanding promising results using hemoadsorption (CytoSorb), questions remain concerning timing and dosing. We created a dynamic scoring system (DSS) to assess patients with early septic shock and performed a first evaluation of the system in this patient population. Methods: Data from 502 patients with septic shock according to Sepsis-3 criteria were retrospectively analyzed. Score parameters were documented at the time of diagnosis (T0) and 6 h later (T6) to calculate a dynamic score. Survival on day 7 and 56 as well as ICU and hospital mortality were analyzed in regard to the score as well as the delay of hemoadsorption therapy. Results: Of the 502 patients analyzed, 198 received adjunctive CytoSorb treatment and 304 received standard therapy. Septic shock was typically represented by 5 points, while >6 points indicated a situation refractory to standard therapy with the worst outcome in patients shown by >8 points. The differences in mortality between the score groups (<6, 6–8, >8 points) were significant. Analysis further showed a significant 56-day, ICU and hospital survival advantage in CytoSorb patients when therapy was started early. Conclusion: We created a scoring system allowing for the assessment of the clinical development of patients in the early phase of septic shock. Applying this approach, we were able to detect populations with a distinct mortality pattern. The data also showed that an early start of CytoSorb therapy was associated with significantly improved survival. As a next step, this easy-to-apply scoring system would require validation in a prospective manner to learn whether patients to be treated with hemoadsorption therapy in the course of septic shock could thereby be identified.

Renal Replacement Techniques in Septic Shock

“…Although a direct comparison between CytoSorb-treated patients and controls was not reported, improved survival was observed in the CytoSorb group in patients who initiated CytoSorb hemoadsorption earlier (≤12 h vs. >24 h, p = 0.037). However, CytoSorb therapy was not associated with 56-day survival ( p = 0.095) in a multivariable analysis of a subset of patients who received CytoSorb or CRRT and standard care [ 86 ]. Finally, CytoSorb therapy was not associated with improved survival in a recent meta-analysis assessing the effect of different extracorporeal blood purification techniques on mortality in patients with sepsis [ 87 ].…”

Therapeutic Modulation of the Host Defense by Hemoadsorption with CytoSorb®—Basics, Indications and Perspectives—A Scoping Review

“…85 h), is associated with lower mortality [ 72 ]. More retrospective studies demonstrated a mortality benefit for hemoadsorption [ 81 ], especially if CytoSorb ® therapy was started early (within 12 h) [ 82 ]. On the other hand, several recently published studies have failed to demonstrate any effect of hemoadsorption on mortality [ 74 , 83 ].…”

“…On the other hand, it remains undetermined which patients, if any, could potentially benefit from such a therapy. Possibly, a recently presented dynamic scoring system may be useful to help identifying the right patients [ 82 ]. None of these have been scrutinized by adequately powered randomized controlled trials.…”

On the Use of Hemadsorption with CytoSorb in Patients with Septic Shock. Comment on Kogelmann et al. First Evaluation of a New Dynamic Scoring System Intended to Support Prescription of Adjuvant CytoSorb Hemoadsorption Therapy in Patients with Septic Shock. J. Clin. Med. 2021, 10, 2939

“…With great interest we read the article by Klaus Kogelmann and co-authors on the "First Evaluation of a New Dynamic Scoring System Intended to Support Prescription of Adjuvant CytoSorb Hemoadsorption Therapy in Patients with Septic Shock" [1]. The authors report interesting data from a retrospective evaluation of 502 patients in septic shock treated in four centers in Germany; 198 of these patients received adjunctive CytoSorb treatment.…”