Objective We report on the effect of hemoadsorption therapy to reduce
cytokines in septic patients with respiratory failure. Methods This was a
randomized, controlled, open-label, multicenter trial. Mechanically ventilated
patients with severe sepsis or septic shock and acute lung injury or acute
respiratory distress syndrome were eligible for study inclusion. Patients were
randomly assigned to either therapy with CytoSorb hemoperfusion for 6 hours
per day for up to 7 consecutive days (treatment), or no hemoperfusion
(control). Primary outcome was change in normalized IL-6-serum concentrations
during study day 1 and 7. Results 97 of the 100 randomized patients were
analyzed. We were not able to detect differences in systemic plasma IL-6
levels between the two groups (n = 75; p = 0.15). Significant IL-6
elimination, averaging between 5 and 18% per blood pass throughout the entire
treatment period was recorded. In the unadjusted analysis, 60-day-mortality
was significantly higher in the treatment group (44.7%) compared to the
control group (26.0%; p = 0.039). The proportion of patients receiving renal
replacement therapy at the time of enrollment was higher in the treatment
group (31.9%) when compared to the control group (16.3%). After adjustment for
patient morbidity and baseline imbalances, no association of hemoperfusion
with mortality was found (p = 0.19). Conclusions In this patient population
with predominantly septic shock and multiple organ failure, hemoadsorption
removed IL-6 but this did not lead to lower plasma IL-6-levels. We did not
detect statistically significant differences in the secondary outcomes
multiple organ dysfunction score, ventilation time and time course of
oxygenation