Efficiency of Extracorporeal Therapies in Sepsis and Septic Shock: A Prospective Observational Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND AIMS: Sepsis and Septic Shock still pose significant challenges in terms of mortality in critical care. In-depth studies on the pathophysiology of sepsis and septic shock have warranted newer advances in the treatment strategies. Recent advances suggest extracorporeal therapies (ECT) as promising interventions for modulating the inflammatory responses associated with sepsis. The concept of ECT is based on the objective of nonspecific clearance of inflammatory mediators and/or toxins, attenuating the overwhelming systemic expression of inflammatory mediators in the early phase of sepsis (surge response). This prospective observational study aims to examine the efficiency of Extracorporeal therapy (Cytosorb® device, oXiris®) in patients with sepsis and septic shock. AIM: To study the decline of inflammatory markers and a decrease of IL6 to 40% of the basal level decrease of procalcitonin to 40% of the basal level. METHODS: This open label prospective observational study included all adult patients with sepsis and septic shock as per Sepsis3 criteria. Parameters such as SOFA score, APACHEII, Procalcitonin, IL-6, CRP, vasopressor requirement, were measured at T0, T12, T24 hours after initiation of ECT. RESULT: Preliminary results of the study reveal a decline of inflammatory markers (%decline in procalcitonin 45.2, p = 0.30; %decline of IL6: 72.08%, p = 0.91%; Decrease of Ferritin: 22.5% p = 0.8; %decrease of lactate: 53.2% p = 0.002) but the change was statistically insignificant. However SOFA scores (p = 0.004) and lactates (p = 0.002) showed a significant decline.(1–3) CONCLUSION: Preliminary results suggest that ECT can be implemented in sepsis and septic shock patients. The inflammatory markers showed a persistent decline. The monitoring of some inflammatory markers including IL-6, Lactates, CRP were more reflective and better suited than those of others like D-Dimer and Ferritin which showed a relatively lesser decreasing trend. These markers can be further studied in detail. Although the current sample size is small to draw conclusions regarding mortality but the study reveals the steady decline of the inflammatory markers. The declining trend of inflammatory markers did not necessarily correlate with the clinical parameters of the enrolled patients in view of the small sample size and design of the study but may be used as a directive in future studies. This study aims to address the paucity of randomised controlled trials in this domain and the clinical utility of ECT in management of sepsis and septic shock.
Authors: Sandeep Dewan, Munish Chauhan, Supriya Kumar
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4410920838