CytoSorb<sup>®</sup> Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory Support
<b>Background:</b> Cardiogenic shock (CS), characterized by inadequate tissue perfusion due to cardiac dysfunction, has a high mortality rate despite advances in treatment. Systemic inflammation and organ failure exacerbate the severity of CS. Extracorporeal hemadsorption techniques such...
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2025-01-01
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| author | Julian Kreutz Lukas Harbaum Cem Benin Barutcu Amar Sharif Rehman Nikolaos Patsalis Klevis Mihali Georgios Chatzis Maryana Choukeir Styliani Syntila Bernhard Schieffer Birgit Markus |
| author_facet | Julian Kreutz Lukas Harbaum Cem Benin Barutcu Amar Sharif Rehman Nikolaos Patsalis Klevis Mihali Georgios Chatzis Maryana Choukeir Styliani Syntila Bernhard Schieffer Birgit Markus |
| author_sort | Julian Kreutz |
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| description | <b>Background:</b> Cardiogenic shock (CS), characterized by inadequate tissue perfusion due to cardiac dysfunction, has a high mortality rate despite advances in treatment. Systemic inflammation and organ failure exacerbate the severity of CS. Extracorporeal hemadsorption techniques such as CytoSorb<sup>®</sup> have been introduced to control inflammation. However, evidence of their efficacy, particularly in patients on various mechanical circulatory support (MCS) systems, remains limited. <b>Methods:</b> This retrospective study analyzed data from 129 CS patients treated with CytoSorb<sup>®</sup> at the University Hospital of Marburg between August 2019 and December 2023. Those patients receiving MCS were grouped according to MCS type: (1) Impella, (2) VA-ECMO, and (3) ECMELLA. The hemodynamic parameters of circulatory support (e.g., MCS flow rates and vasoactive inotropic score, VIS) and laboratory and ventilation parameters were assessed 24 h before start of CytoSorb<sup>®</sup> therapy (T1) and 24 h after completion of CytoSorb<sup>®</sup> therapy (T2). <b>Results:</b> Of 129 CS patients (mean age: 64.7 ± 13.1 years), 103 (79.8%) received MCS. Comparing T1 and T2, there was a significant reduction in VIS in the entire cohort (T1: 38.0, T2: 16.3; <i>p</i> = 0.002), with a concomitant significant reduction in the level of MCS support in all subgroups, indicating successful weaning. Analysis of laboratory parameters showed significant reductions in lactate (T1: 2.1, T2: 1.3 mmol/L; <i>p</i> = 0.014), myoglobin (T1: 1549.0, T2: 618.0 µg/L; <i>p</i> < 0.01), lactate dehydrogenase (T1: 872.0, T2: 632.0 U/L; <i>p</i> = 0.048), and procalcitonin (T1: 2.9, T2: 1.6 µg/L; <i>p</i> < 0.001). However, a significant decrease in platelets (T1: 140.0, T2: 54.0 tsd/µL; <i>p</i> < 0.001) and albumin (T1: 25.0, T2: 22.0 g/dL; <i>p</i> < 0.001) was also documented. The median SOFA score of the entire cohort was 15.0 (IQR 12.0–16.0), predicting a mortality rate of >80%, which could be reduced to 60.5% in the present study. <b>Conclusions:</b> During CytoSorb<sup>®</sup> therapy in CS, a significant reduction in VIS was demonstrated, resulting in improved organ perfusion. Therefore, the results of this study underline that CytoSorb<sup>®</sup> therapy can be considered a useful “component” in the complex management of CS, especially when combined with MCS. To refine and optimize treatment strategies in CS, prospective studies are needed to better define the role of hemadsorption. |
| format | Article |
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| language | English |
| publishDate | 2025-01-01 |
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| series | Biomedicines |
| spelling | doaj-art-aa53582d64944db4a7740ac4feec84592025-08-20T03:12:10ZengMDPI AGBiomedicines2227-90592025-01-0113232410.3390/biomedicines13020324CytoSorb<sup>®</sup> Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory SupportJulian Kreutz0Lukas Harbaum1Cem Benin Barutcu2Amar Sharif Rehman3Nikolaos Patsalis4Klevis Mihali5Georgios Chatzis6Maryana Choukeir7Styliani Syntila8Bernhard Schieffer9Birgit Markus10Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany<b>Background:</b> Cardiogenic shock (CS), characterized by inadequate tissue perfusion due to cardiac dysfunction, has a high mortality rate despite advances in treatment. Systemic inflammation and organ failure exacerbate the severity of CS. Extracorporeal hemadsorption techniques such as CytoSorb<sup>®</sup> have been introduced to control inflammation. However, evidence of their efficacy, particularly in patients on various mechanical circulatory support (MCS) systems, remains limited. <b>Methods:</b> This retrospective study analyzed data from 129 CS patients treated with CytoSorb<sup>®</sup> at the University Hospital of Marburg between August 2019 and December 2023. Those patients receiving MCS were grouped according to MCS type: (1) Impella, (2) VA-ECMO, and (3) ECMELLA. The hemodynamic parameters of circulatory support (e.g., MCS flow rates and vasoactive inotropic score, VIS) and laboratory and ventilation parameters were assessed 24 h before start of CytoSorb<sup>®</sup> therapy (T1) and 24 h after completion of CytoSorb<sup>®</sup> therapy (T2). <b>Results:</b> Of 129 CS patients (mean age: 64.7 ± 13.1 years), 103 (79.8%) received MCS. Comparing T1 and T2, there was a significant reduction in VIS in the entire cohort (T1: 38.0, T2: 16.3; <i>p</i> = 0.002), with a concomitant significant reduction in the level of MCS support in all subgroups, indicating successful weaning. Analysis of laboratory parameters showed significant reductions in lactate (T1: 2.1, T2: 1.3 mmol/L; <i>p</i> = 0.014), myoglobin (T1: 1549.0, T2: 618.0 µg/L; <i>p</i> < 0.01), lactate dehydrogenase (T1: 872.0, T2: 632.0 U/L; <i>p</i> = 0.048), and procalcitonin (T1: 2.9, T2: 1.6 µg/L; <i>p</i> < 0.001). However, a significant decrease in platelets (T1: 140.0, T2: 54.0 tsd/µL; <i>p</i> < 0.001) and albumin (T1: 25.0, T2: 22.0 g/dL; <i>p</i> < 0.001) was also documented. The median SOFA score of the entire cohort was 15.0 (IQR 12.0–16.0), predicting a mortality rate of >80%, which could be reduced to 60.5% in the present study. <b>Conclusions:</b> During CytoSorb<sup>®</sup> therapy in CS, a significant reduction in VIS was demonstrated, resulting in improved organ perfusion. Therefore, the results of this study underline that CytoSorb<sup>®</sup> therapy can be considered a useful “component” in the complex management of CS, especially when combined with MCS. To refine and optimize treatment strategies in CS, prospective studies are needed to better define the role of hemadsorption.https://www.mdpi.com/2227-9059/13/2/324CytoSorb<sup>®</sup>hemadsorptioncardiogenic shockmechanical circulatory support |
| spellingShingle | Julian Kreutz Lukas Harbaum Cem Benin Barutcu Amar Sharif Rehman Nikolaos Patsalis Klevis Mihali Georgios Chatzis Maryana Choukeir Styliani Syntila Bernhard Schieffer Birgit Markus CytoSorb<sup>®</sup> Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory Support Biomedicines CytoSorb<sup>®</sup> hemadsorption cardiogenic shock mechanical circulatory support |
| title | CytoSorb<sup>®</sup> Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory Support |
| title_full | CytoSorb<sup>®</sup> Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory Support |
| title_fullStr | CytoSorb<sup>®</sup> Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory Support |
| title_full_unstemmed | CytoSorb<sup>®</sup> Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory Support |
| title_short | CytoSorb<sup>®</sup> Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory Support |
| title_sort | cytosorb sup r sup hemadsorption in cardiogenic shock a real world analysis of hemodynamics organ function and clinical outcomes during mechanical circulatory support |
| topic | CytoSorb<sup>®</sup> hemadsorption cardiogenic shock mechanical circulatory support |
| url | https://www.mdpi.com/2227-9059/13/2/324 |
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