The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial

• Published in: PloS one 2017-10, Vol.12 (10), p.e0187015-e0187015
• Main Authors: Schädler, Dirk, Pausch, Christine, Heise, Daniel, Meier-Hellmann, Andreas, Brederlau, Jörg, Weiler, Norbert, Marx, Gernot, Putensen, Christian, Spies, Claudia, Jörres, Achim, Quintel, Michael, Engel, Christoph, Kellum, John A, Kuhlmann, Martin K
• Format: Article
• Language: English
• Subjects: Aged; Anesthesiology; Care and treatment; Complications and side effects; Cytokines; Cytokines - metabolism; Epidemiology; Feasibility studies; Female; Health aspects; Health informatics; Hemoperfusion; Hemoperfusion - methods; Humans; Intensive care; Interleukin 6; Interleukin-6 - blood; Interleukin-6 - isolation & purification; Kidney transplantation; Kidneys; Lungs; Male; Mechanical ventilation; Medicine; Middle Aged; Morbidity; Mortality; Nephrology; Oxygenation; Patient outcomes; Patients; Physiological aspects; Plasma; Randomization; Respiratory distress syndrome; Respiratory insufficiency; Sepsis; Sepsis - blood; Septic shock; Statistical analysis; Therapy; Tumor necrosis factor-TNF; Ventilation
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0187015

We report on the effect of hemoadsorption therapy to reduce cytokines in septic patients with respiratory failure. This was a randomized, controlled, open-label, multicenter trial. Mechanically ventilated patients with severe sepsis or septic shock and acute lung injury or acute respiratory distress syndrome were eligible for study inclusion. Patients were randomly assigned to either therapy with CytoSorb hemoperfusion for 6 hours per day for up to 7 consecutive days (treatment), or no hemoperfusion (control). Primary outcome was change in normalized IL-6-serum concentrations during study day 1 and 7. 97 of the 100 randomized patients were analyzed. We were not able to detect differences in systemic plasma IL-6 levels between the two groups (n = 75; p = 0.15). Significant IL-6 elimination, averaging between 5 and 18% per blood pass throughout the entire treatment period was recorded. In the unadjusted analysis, 60-day-mortality was significantly higher in the treatment group (44.7%) compared to the control group (26.0%; p = 0.039). The proportion of patients receiving renal replacement therapy at the time of enrollment was higher in the treatment group (31.9%) when compared to the control group (16.3%). After adjustment for patient morbidity and baseline imbalances, no association of hemoperfusion with mortality was found (p = 0.19). In this patient population with predominantly septic shock and multiple organ failure, hemoadsorption removed IL-6 but this did not lead to lower plasma IL-6-levels. We did not detect statistically significant differences in the secondary outcomes multiple organ dysfunction score, ventilation time and time course of oxygenation.