CytoSorb hemoadsorption in diverse hyperinflammatory states with multi-organ dysfunction: a clinical case series

Abstract

Hyperinflammatory syndromes resulting in cytokine storm are a major contributor to morbidity and mortality in critically ill patients with infections and systemic inflammatory conditions. CytoSorb hemoadsorption therapy has been increasingly utilized as an adjunctive modality to mitigate excessive cytokine burden. This study aimed to evaluate the clinical utility of CytoSorb therapy across diverse hyperinflammatory conditions presenting with multi-organ dysfunction. This case series describes three patients with distinct etiologies-severe malaria with acute liver failure, dengue-associated hemophagocytic lymphohistiocytosis (HLH), and septic shock with cardiomyopathy-who developed multi-organ dysfunction and were treated with CytoSorb therapy alongside standard care. Clinical, biochemical, and hemodynamic parameters were monitored before, during, and after CytoSorb intervention. Inflammatory markers including C-reactive protein (CRP), procalcitonin, interleukin-6 (IL-6), and ferritin were evaluated. Across all cases, CytoSorb therapy was associated with marked clinical improvement, including stabilization of hemodynamics, reduction in inflammatory markers (e.g., CRP decreased from 245.4 to 5.8 mg/l), and recovery of organ function. Patient A required three CytoSorb sessions integrated with sustained low-efficiency dialysis (SLED) for severe malaria-associated multi-organ dysfunction. Patient B received two sessions during HLH-associated hyperinflammation. Patient C underwent one session during peak cytokine surge in septic shock with cardiomyopathy. All patients achieved 100% survival with de-escalation to ward care. CytoSorb hemoadsorption demonstrates potential therapeutic utility across heterogeneous cytokine-driven conditions when initiated early and combined with standard care. These findings support the integration of extracorporeal cytokine removal as an adjunctive strategy in critically ill patients with hyperinflammatory states.