Impact of CytoSorb® on interleukin-6 in cardiac surgery
Daniela Geisler1,2, Noemi Arleth3, Johannes Grabenwöger3
1Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria.
Insights
This study found that CytoSorb® hemadsorption (HA) did not significantly reduce interleukin-6 (IL-6) levels or mortality in cardiac surgery patients. However, it did show a reduced immune response in patients with a high Euroscore II.
Area of Science:
- Cardiology
- Immunology
- Surgical Critical Care
Background:
- Cardiac surgery triggers inflammatory responses, potentially increasing morbidity and mortality.
- Hemadsorption (HA) devices like CytoSorb® aim to mitigate this overshooting immune response.
- Interleukin-6 (IL-6) is a key inflammatory mediator in this context.
Purpose of the Study:
- To investigate the effect of CytoSorb® hemadsorption on IL-6 levels in patients undergoing complex cardiac surgery.
- To compare IL-6 levels and periprocedural mortality between a CytoSorb® group and a control group.
Main Methods:
- Retrospective analysis of 56 patients (28 CytoSorb®, 28 control) undergoing cardiac surgery.
- Primary endpoint: difference in IL-6 levels between groups.
- Secondary endpoint: periprocedural mortality.
Main Results:
- CytoSorb® did not significantly affect IL-6 levels (p=0.856).
- No significant difference in periprocedural mortality was observed (p=0.996).
- Patients with Euroscore II ≥ 7 showed a reduced IL-6 response compared to those with Euroscore II < 7 (p=0.00306).
Conclusions:
- Intraoperative hemadsorption with CytoSorb® did not significantly reduce IL-6 levels or mortality in cardiac surgery.
- A blunted IL-6 response was observed in high-risk patients (Euroscore II ≥ 7).
- Further prospective randomized studies are needed to evaluate the routine use of CytoSorb® in cardiac surgery.
Objective:
Cardiac surgery is known to activate a cascade of inflammatory mediators leading to a systemic inflammatory response. Hemadsorption (HA) devices such as CytoSorb® have been postulated to mitigate an overshooting immune response, which is associated with increased morbidity and mortality, and thus improve outcome. We aimed to investigate the effect of CytoSorb® on interleukin (IL)-6 levels in patients undergoing complex cardiac surgery in comparison to a control group.
Methods:
A total of 56 patients (28 CytoSorb®, 28 control) undergoing acute and elective cardiac surgery between January 2020 and February 2021 at the Department of Cardiac and Vascular Surgery, Clinic Floridsdorf, Vienna, were retrospectively analyzed. The primary endpoint was the difference in IL-6 levels between the CytoSorb® and control group. Secondary endpoint was periprocedural mortality.
Results:
CytoSorb®, installed in the bypass circuit, had no significant effect on IL-6 levels. IL-6 peaked on the first postoperative day (HA: 775.3 ± 838.4 vs. control: 855.5 ± 1,052.9 pg/ml, p = 0.856). In total, three patients died in the HA group, none in the control (logistic regression model, p = 0.996). Patients with an increased Euroscore II of 7 or more showed a reduced IL-6 response compared to patients with an Euroscore II below 7 (178.3 ± 63.1 pg/ml vs. 908.6 ± 972.6 pg/ml, p-value = 0.00306).
Conclusions:
No significant reduction of IL-6 levels or periprocedural mortality through intraoperative HA with CytoSorb® in patients undergoing cardiac surgery was observed. However, this study was able to show a reduced immunologic response in patients with a high Euroscore II. The routine application of CytoSorb® in cardiac surgery to reduce inflammatory mediators has to be scrutinized in future prospective randomized studies.
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