Affecting Morbidity through Cytosorb Filters: A Propensity Score Analysis in 631 Patients

Background: Systemic inflammatory reaction syndromes (SIRS) increase morbidity and mortality in cardiac surgery. Cytokines are considered mediators of the SIRS and can be eliminated using filters. The degree of illness and the optimal time to use the filter and optimal course parameters to have a favorable effect on morbidity are unclear.

Method: A total of 631 cardiac surgery patients were analyzed for postoperative morbidity and mortality in the context of SIRS and additive Cytosorb therapy besides standard regime. The retrospective study of the all-comers cohort was controlled according to propensity score matching (2:1). We analyzed according to stress phases in ICU-therapy and with regard to the 30-day outcome according to the time of Cytosorb initiation, anti-inflammatory effectiveness, intensive medical morbidity reduction, and mortality.

Results: Patients with primary rapidly increasing and higher CRP on days 1 to 2 (169.02 mg/L; versus control: 8 mg/L; p ≤ 0.001), days 3 to 7 (197.89 mg/L; versus control: 159 mg/L; p = 0.006), showed increased mortality (p ≤ 0.001), morbidity and ventilation time (15 d, 5; versus control 0.5 d; p ≤ 0.001). Early inflammatory activation resulted more often in Cytosorb initiation. PCT values (days 1–2: p = 0.071; days 3–7: p = 0.822) were absolutely reduced under Cytosorb therapy and could be reduced to the level of the control group. The relative increase of inflammation markers was reduced under Cytosorb besides higher levels at initiation of therapy compared with controls. The inflammatory dysregulation showed time-dependent significant differences (begin Cytosorb therapy) re-grading leukocyte counts (<5 days post-OP: 10.44 giga/L ± 6.773; > 5 days post-op: 20.1 giga/L ± 8.609; p = 0.002) and the PCT values (<5 days post-op: 13 µg/L; > 5 days post-op: 4.7 µg/L; p = 0.037). Early Cytosorb therapy reduced need of ventilation. Subsequent use though reduced acute mortality, but prolonged ventilation phases (<5 days post-op: 4 days; > 5 days post-op: 20 days; p ≤ 0.004). The overall mortality was not significantly reduced (p = 0.243).

Conclusion: Early use of Cytosorb can help reduce morbidity. With successful Cytosorb therapy, PCT is reduced rapidly, an increase in CRP and leukocytosis is mitigated. A significant reduction in medium-term mortality could not be traced in this cohort.

Publication History

Article published online:
03 February 2022