Kreutz Julian, Harbaum Lukas, Barutcu Cem Benin, Rehman Amar Sharif, Patsalis Nikolaos, Mihali Klevis, Chatzis Georgios, Choukeir Maryana, Syntila Styliani, Schieffer Bernhard, Markus Birgit
Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany.
Biomedicines. 2025 Jan 30;13(2):324. doi: 10.3390/biomedicines13020324.
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 have been introduced to control inflammation. However, evidence of their efficacy, particularly in patients on various mechanical circulatory support (MCS) systems, remains limited. This retrospective study analyzed data from 129 CS patients treated with CytoSorb 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 therapy (T1) and 24 h after completion of CytoSorb therapy (T2). 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; = 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; = 0.014), myoglobin (T1: 1549.0, T2: 618.0 µg/L; < 0.01), lactate dehydrogenase (T1: 872.0, T2: 632.0 U/L; = 0.048), and procalcitonin (T1: 2.9, T2: 1.6 µg/L; < 0.001). However, a significant decrease in platelets (T1: 140.0, T2: 54.0 tsd/µL; < 0.001) and albumin (T1: 25.0, T2: 22.0 g/dL; < 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. During CytoSorb therapy in CS, a significant reduction in VIS was demonstrated, resulting in improved organ perfusion. Therefore, the results of this study underline that CytoSorb 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.
心源性休克（CS）的特征是由于心脏功能障碍导致组织灌注不足，尽管治疗取得了进展，但死亡率仍然很高。全身炎症和器官衰竭会加重CS的严重程度。已经引入了诸如CytoSorb之类的体外血液吸附技术来控制炎症。然而，它们的疗效证据，特别是在使用各种机械循环支持（MCS）系统的患者中，仍然有限。这项回顾性研究分析了2019年8月至2023年12月期间在马尔堡大学医院接受CytoSorb治疗的129例CS患者的数据。那些接受MCS的患者根据MCS类型进行分组：（1）Impella，（2）VA-ECMO，和（3）ECMELLA。在开始CytoSorb治疗前24小时（T1）和完成CytoSorb治疗后24小时（T2）评估循环支持的血流动力学参数（例如，MCS流速和血管活性药物评分，VIS）以及实验室和通气参数。在129例CS患者（平均年龄：64.7±13.1岁）中，103例（79.8%）接受了MCS。比较T1和T2，整个队列中的VIS显著降低（T1：38.0，T2：16.3；P = 0.002），所有亚组中的MCS支持水平也随之显著降低，表明成功撤机。实验室参数分析显示乳酸水平显著降低（T1：2.1，T2：1.3 mmol/L；P = 0.014）、肌红蛋白（T1：1549.0，T2：618.0 µg/L；P < 0.01）、乳酸脱氢酶（T1：872.0，T2：632.0 U/L；P = 0.048）和降钙素原（T1：2.9，T2：1.6 µg/L；P < 0.001）。然而，血小板（T1：140.0，T2：54.0 tsd/µL；P < 0.001）和白蛋白（T1：25.0，T2：22.0 g/dL；P < 0.001）也有显著下降。整个队列的中位序贯器官衰竭评估（SOFA）评分为15.0（四分位间距12.0 - 16.0），预测死亡率>80%，而在本研究中可降至60.5%。在CS的CytoSorb治疗期间，VIS显著降低，导致器官灌注改善。因此，本研究结果强调，CytoSorb治疗可被视为CS综合管理中的一种有用“组成部分”，特别是与MCS联合使用时。为了完善和优化CS的治疗策略，需要进行前瞻性研究以更好地确定血液吸附的作用。
