Adsorption therapy in critically ill with septic shock and acute kidney injury: a retrospective and prospective cohort study

Gregor A Schittek; Philipp Zoidl; Michael Eichinger; Simon Orlob; Holger Simonis; Martin Rief; Philipp Metnitz; Tobias Fellinger; Jens Soukup

doi:10.1186/s13613-020-00772-7

Adsorption therapy in critically ill with septic shock and acute kidney injury: a retrospective and prospective cohort study

Ann Intensive Care. 2020 Nov 18;10(1):154. doi: 10.1186/s13613-020-00772-7.

Authors

Gregor A Schittek¹, Philipp Zoidl², Michael Eichinger², Simon Orlob², Holger Simonis², Martin Rief², Philipp Metnitz², Tobias Fellinger³, Jens Soukup⁴

Affiliations

¹ Department of Anaesthesiology and Intensive Care Medicine, Division of General Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria. gregor.schittek@medunigraz.at.
² Department of Anaesthesiology and Intensive Care Medicine, Division of General Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
³ Austrian Centre for Documentation and Quality Assurance in Intensive Care, Vienna, Austria.
⁴ Department of Anaesthesiology, Intensive and Palliative Care, Carl-Thiem-Hospital Cottbus, Cottbus, Germany.

Abstract

Background: Haemoadsorption has been described as an effective way to control increased pro- and anti-inflammatory mediators ("cytokine storm") in septic shock patients. No prospective or randomised clinical study has yet confirmed these results. However, no study has yet prospectively specifically investigated patients in severe septic shock with sepsis-associated acute kidney injury (SA-AKI). Therefore, we aimed to examine whether haemoadsorption could influence intensive care unit (ICU) and hospital mortality in these patients. Furthermore, we examined the influence of haemoadsorption on length of stay in the ICU and therapeutic support.

Methods: Retrospective control group and prospective intervention group design in a tertiary hospital in central Europe (Germany). Intervention was the implementation of haemoadsorption for patients in septic shock with SA-AKI. 76 patients were included in this analysis.

Results: Severity of illness as depicted by APACHE II was higher in patients treated with haemoadsorption. Risk-adjusted ICU mortality rates (O/E ratios) did not differ significantly between the groups (0.80 vs. 0.83). We observed in patients treated with haemoadsorption a shorter LOS and shorter therapeutic support such as catecholamine dependency and duration of RRT. However, in multivariate analysis (logistic regression for mortality, competing risk for LOS), we found no significant differences between the two groups.

Conclusions: The implementation of haemoadsorption for patients in septic shock with acute renal failure did not lead to a reduction in ICU or hospital mortality rates. Despite univariate analysis delivering some evidence for a shorter duration of ICU-related treatments in the haemoadsorption group, these results did not remain significant in multivariate analysis. Trial registration CytoSorb^® registry https://clinicaltrials.gov/ct2/show/NCT02312024 . December 9, 2014.

Database: https://www.cytosorb-registry.org/ (registration for content acquisition is necessary).

Keywords: Acute kidney injury; Cytosorb; Haemoadsorption; Mortality; Outcome; Sepsis; Septic shock.

Associated data

ClinicalTrials.gov/NCT02312024