PMID- 33352555
OWN - NLM
STAT- MEDLINE
DCOM- 20220131
LR  - 20220131
IS  - 1421-9735 (Electronic)
IS  - 0253-5068 (Linking)
VI  - 50
IP  - 4-5
DP  - 2021
TI  - Improved Survival beyond 28 Days up to 1 Year after CytoSorb Treatment for 
      Refractory Septic Shock: A Propensity-Weighted Retrospective Survival Analysis.
PG  - 539-545
LID - 10.1159/000512309 [doi]
AB  - BACKGROUND AND AIMS: It is currently unknown whether CytoSorb treatment for 
      septic shock improves long-term survival beyond 28 days from intensive care unit 
      (ICU) admission and which factors determine outcome. METHODS: This was a 
      long-term follow-up retrospective analysis of patients with septic shock who were 
      treated with continuous renal replacement therapy (CRRT) + CytoSorb (n = 67) or 
      CRRT alone (n = 49). These patients were previously analyzed for 28-day 
      mortality. The primary outcome was the time to long-term all-cause mortality. 
      Factors associated with time to event were analyzed both weighted by stabilized 
      inverse probability of treatment weights (sIPTW) as well as unweighted stratified 
      by therapy received. RESULTS: The median follow-up for the total cohort was 30 
      days (interquartile range [IQR]: 5-334, maximum 1,059 days) after ICU admission 
      and 333 days (IQR: 170-583) for those who survived beyond 28 days (n = 59). 
      Survival beyond 28 days was sustained up to 1 year after ICU admission for both 
      treatment regimens: 80% (standard error [SE] 7%) vs. 87% (SE 7%), for CytoSorb 
      vs. CRRT, respectively, p = 0.853. By sIPTW, CytoSorb was significantly 
      associated with long-term outcome compared to CRRT (adjusted hazard ratio [aHR] 
      0.59, 95% confidence interval [CI] 0.37-0.93, p = 0.025). Independent factors 
      associated with long-term outcome in CytoSorb-treated patients were baseline 
      log10 lactate levels (aHR 5.1, p = 0.002), age in the presence of comorbidity 
      (aHR 2.60, p = 0.013), and presence of abdominal sepsis (aHR 0.34, p = 0.004). A 
      lactate level above 6.0 mmol/L at the start of CytoSorb therapy had a positive 
      predictive value of 79% for mortality (p = 0.013). CONCLUSIONS: Survival is 
      achieved with CytoSorb and CRRT for patients with septic shock beyond 28 days 
      from ICU admission and may be improved for CytoSorb treatment. Lactate levels 
      above 6.0 mmol/L at the start of CytoSorb therapy are predictive of worse outcome 
      with high specificity and positive predictive value.
CI  - (c) 2020 The Author(s). Published by S. Karger AG, Basel.
FAU - Brouwer, Willem P
AU  - Brouwer WP
AD  - Department of Gastroenterology & Hepatology, Erasmus MC, University Medical 
      Center Rotterdam, Rotterdam, The Netherlands, w.p.brouwer@erasmusmc.nl.
AD  - Department of Internal Medicine, Maasstad Ziekenhuis, Rotterdam, The Netherlands, 
      w.p.brouwer@erasmusmc.nl.
FAU - Duran, Servet
AU  - Duran S
AD  - Department of Intensive Care Medicine, Maasstad Ziekenhuis, Rotterdam, The 
      Netherlands.
FAU - Ince, Can
AU  - Ince C
AD  - Department of Intensive Care Medicine, Erasmus MC, University Medical Center 
      Rotterdam, Rotterdam, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20201222
PL  - Switzerland
TA  - Blood Purif
JT  - Blood purification
JID - 8402040
SB  - IM
MH  - Aged
MH  - *Continuous Renal Replacement Therapy
MH  - Female
MH  - Humans
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Shock, Septic/*therapy
MH  - Sorption Detoxification
MH  - Survival Analysis
MH  - Treatment Outcome
OTO - NOTNLM
OT  - CytoSorb
OT  - Cytosorbent
OT  - Hemofiltration
OT  - Mortality
OT  - Outcome
OT  - Sepsis
OT  - Septic shock
OT  - Treatment
EDAT- 2020/12/23 06:00
MHDA- 2022/02/01 06:00
CRDT- 2020/12/22 20:14
PHST- 2020/05/23 00:00 [received]
PHST- 2020/10/02 00:00 [accepted]
PHST- 2020/12/23 06:00 [pubmed]
PHST- 2022/02/01 06:00 [medline]
PHST- 2020/12/22 20:14 [entrez]
AID - 000512309 [pii]
AID - 10.1159/000512309 [doi]
PST - ppublish
SO  - Blood Purif. 2021;50(4-5):539-545. doi: 10.1159/000512309. Epub 2020 Dec 22.