CytoSorbents Corporation (CTSO)

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Case of the week 13/2016
Septic shock secondary to ß-hemolytic streptococcus-induced necrotizing fasciitis treated with a novel cytokine adsorption therapy

Hetz H, Berger R, Recknagel P, Steltzer H
AUVA Meidling Emergency Hospital, Department of Anesthesiology and Intensive Care Medicine, Vienna, Austria
Summary:

This case study reports on a 60-year-old female with no pre-existing diseases except hypertension and hypothyroidism presented at the hospital with radius fracture of the right forearm after an accident.
Case presentation

Immediate wound care was achieved by application of a plaster splint followed by operative osteosynthesis on the same day
Swelling of the forearm expanding to the upper arm
Patient collapsed and was transferred to ICU with diagnosis of septic shock
Antibiosis and volume therapy were initiated while requirement for vasopressors drastically increased
Development of oliguric acute renal failure and ARDS and commencement of mechanical ventilation
Implementation of continuous veno-venous hemofiltration in combination with CytoSorb
In the further course proof of infection with ß-hemolytic streptococci
Treatment

Three CytoSorb hemoperfusion sessions on the first day as well as on day 3 and 4 after ICU admission in combination with standard CVVHD
Treatment time was 36 hours in the first and 17-18 hours in the two following procedures
Blood flow rates 100 ml/min
Regional citrate anticoagulation
Measurements

Markers of inflammation, organ dysfunction and need for vasopressors
Leucocytes, platelets, IL-6, cumulative urine output, creatinine
Results

CytoSorb effectively and significantly reduced IL-6 levels
After the first session, IL-6 plasma concentration decreased from 70000 to 39100 pg/ml (-44.3%). The final IL-6 level after the third session was 66 pg/ml
CytoSorb treatment was paralleled by a significant decrease of vasopressor need
Antibiotic therapy was conducted with Ampicillin and Fosfomycin, with no reported adaption of dosage during CytoSorb therapy
The patient could be successfully stabilized until surgical control of the infectious source was achieved
Patient Follow-Up

After the third CytoSorb treatment hemofiltration was continued without CytoSorb as the need for vasopressors was significantly decreased and IL-6 levels were back in a normal range
Despite considerable reduction of IL-6 levels, amputation was inevitable
The general condition improved and the patient could be extubated 4 days after the third CytoSorb treatment
Conclusions

Treatment was safe and well-tolerated, without adverse events
CytoSorb significantly reduced IL-6, a predictor of mortality in sepsis and surrogate for cytokine storm
The patient could be successfully stabilized until surgical infectious source control was performed
CytoSorb in combination with CVVHD and regional citrate anticoagulation could be run continuously for up to 36 h
Hemoadsorption using CytoSorb seems to represent a promising approach for an effective and safe treatment of severe sepsis and septic shock.
http://cytosorb-therapy.com/the-therapy/case-of-the-week/