CTSO und Sepsis

Amerikanische CTSO-Kollegen haben kürzlich noch mal eine Meldung aus dem Februar 2016 aus dem Hut gezaubert, die sich mit der sogenannten „Greifswald study“ beschäftigt. In der Annahme, dass ihr alle des Englischen mächtig seid, zitiere ich mal ein bisschen:

„Dr. Sigrun Friesecke, Senior Intensivist of the medical intensive care unit (MICU) at Greifswald University in Germany, presented top line data from a prospective, single arm study in 22 patients with refractory late-stage septic shock and multiple organ failure at her institution.  All patients had refractory septic shock despite high doses of vasopressors, respiratory failure requiring artificial ventilation or extracorporeal membrane oxygenation (ECMO), anuric (no urine production) kidney failure requiring dialysis, and a significantly elevated initial mean lactate level of 8 mmol/L, indicating extreme metabolic and physiologic derangement.  In these patients, all intensive care therapeutic options had been exhausted.  Patients underwent consecutive twelve-hour extracorporeal  CytoSorb® treatments over several days, using a new CytoSorb® cartridge for each treatment.

As reported recently by Conrad (2015), a similar patient population (n=16) receiving standard of care treatment with persistent refractory septic shock that could not be reversed, with respiratory failure on mechanical ventilation, initial lactate levels of 6.1 ± 4 mmol/L, and 75% requiring renal replacement therapy had a mortality of 100% at 28 days1.

Preliminary key findings of the CytoSorb® Greifswald study:

  • 28-day-survival was 41%, an approximately 30-40% absolute improvement in survival compared to what was expected (0-10%)
  • Resolution of shock, the main cause for mortality in this patient population, was achieved in 68% of the patients with CytoSorb® therapy, which translated into improvement in clinical outcomes
  • Reduction of IL-6, one of the cytokines most closely associated with severity of illness, inflammation, and mortality in sepsis, decreased rapidly from initial mean values of approximately 87,000 pg/mL, to below 10,000 pg/mL after 24 hours of treatment

Data analysis continues and more details of this study are expected to submitted for publication in the near future.

Dr. Axel Nierhaus, senior consultant at the Department for Intensive Care Medicine at University of Hamburg – Eppendorf, Germany, who chaired the symposium session, summarized the study as a “significant step to establish CytoSorb as a regular therapy for those moribund patients”.

Sepsis is the result of an overzealous immune response to a serious infection often driven by an excessive production of cytokines, or “cytokine storm”, and other inflammatory mediators and toxins.  It is one of the leading causes of death and disability worldwide, striking an estimated 27 million people annually and killing a third of them, despite the use of antibiotics and the best medical care.  Septic shock is the most deadly form of the disease, where patients develop persistent, life-threatening low blood pressure that compromises blood and oxygen delivery to vital organs in the body.  Common to all septic shock patients is the need for vasopressors – potent drugs such as norepinephrine, dobutamine, and vasopressin – that attempt to artificially increase blood pressure by increasing cardiac output or shunting blood from non-vital organs and the arms and legs, to the core vital organs.  Patients who require maximal doses of multiple vasopressors represent the most challenging patients with the highest risk of death.  Refractory septic shock, despite the use of vasopressors, often results in irreversible organ injury due to ischemia and other factors.  The expected mortality of patients with prolonged refractory septic shock, particularly when combined with the failure of other organs, approaches 90-100%.  CytoSorb® is designed to reduce the inflammatory toxins that drive uncontrolled, deadly inflammation and refractory shock, and has been used to help stabilize blood pressure and regain control of many patients, particularly when used early and aggressively.

1 Conrad, M., et. al., “Early prediction of norepinephrine dependency and refractory septic shock with a multimodal approach of vascular failure”, J Crit Care, 2015; 30:739-743.“

Bewertung: schon ganz ordentlich bei dem Patientengut. 41 % = 9 von 22 moribunden Sepsis-Patienten hat man mir hier – zumindest nach 28 Tagen – dem Sensenmann weggeschnappt.

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