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Background: Our aim is to report the results of the ‘liver indication’ subset of patients in the CytoSorb International Registry. Methods: Structured data were recorded. Treatment characteristics and changes from T1 (start of hemoadsorption) to T2 (termination) were evaluated with a special focus on bilirubin, C-reactive protein, procalcitonin, interleukin-6, platelet levels, SOFA scores, mortality, and subjective assessment by the attending physicians. Results: Until January 2021, from the total 1434 patients, 109 (age: 49.2 ± 17.1 years, 57.8% males) received treatment for hyperbilirubinemia. APACHE II-predicted mortality was 49.6 ± 26.8%. In the study, 91% of patients were alive at the termination of hemoadsorption and improvement was observed by the physicians in 75 cases. Overall, 65 (59.6%) patients died in the hospital, and 60 (55.0%) died in the ICU. Patients received a median of two treatments for a median of 43 h (interquartile range: 24–72 h) in total. Serum bilirubin levels reduced significantly to −4.6 (95% CI: −6.329 to −2.8) mg/dL. Thrombocytopenia was reported in four patients as an adverse event. Conclusions: We report the largest case series on hemoadsorption for ‘liver indication’ from the CytoSorb International Registry. The finding of significant bilirubin removal observed in our study could have substantial impact in designing and executing further studies on the effects of hemoadsorption in liver dysfunction, which are certainly warranted., publishedVersion

Aims: Catecholamines represent a cornerstone in the hemodynamic management of septic shock (SS). However, development of toxicity may adversely affect patient outcome. We describe the outcome of 460 consecutive SS patients who were treated with an institutional hemodynamic protocol aimed at decreasing catecholamine toxicity. Study Design: Retrospective observational analysis. Place and Duration of Study: Multidisciplinary intensive care unit in a 460 bed hospital between January 1, 2004 to July 31, 2010. Methodology: Demographic data, premorbidities, admission Simplified Acute Physiology Score (SAPS) II, most aberrant laboratory data, highest dosages of norepinephrine (NE), dobutamine, milrinone, use of ß-adrenoreceptor blocking agents, hydrocortisone and arginine vasopressin (AVP), development of new-onset tachyarrhythmia and myocardial ischemia were analyzed from an electronic database. The institutional hemodynamic treatment protocol includes early administration of hydrocortisol and arginine vasopressin in addition to norepinephrine and aggressive treatment of hyperthermia (T>38.5º). New onset tachyarrhythmia’s/tachycardia were treated using amiodarone and ß-adrenoreceptor blockers to decrease heart rate below 95bpm, respectively. Observed and SAPS-predicted mortality were analyzed for all patients and SAPS-quartiles (QI-QIV) of increasing disease severity. Results: Age, incidence of preexisting heart, renal disease, arterial hypertension, and MODS increased while body mass index significantly declined from QI to QIV. With increasing disease severity, patients received higher dosages of NE, steroids, AVP and milrinone. The incidence of tachycardic atrial fibrillation and myocardial ischemia increased from QI to QIV. Overall, there was no significant difference between the observed and SAPS II predicted mortality (p=0.2, Chi2-test). However, we observed a trend (-12, 2%) towards decreased mortality in QIII (p=0.07) and a significant decrease in hospital mortality (-19%) in QIV (p