Impact of CytoSorb on Kinetics of Vancomycin and Bivalirudin in Critically ill Patients

Abstract

Background: CytoSorb is a promising tool to treat severe inflammatory status with multiple mechanisms in the acute care setting. Its effect on drugs is, however, poorly documented in vivo, although removal of small molecules might translate into decreased blood levels of life-saving medications.

Objective: To assess the impact of CytoSorb on vancomycin and bivalirudin clearance in a large population of critically ill patients.

Methods: Single-centre analysis of CytoSorb treatments performed between January 2018 and March 2019 in critically ill patients admitted to our ICU.

Results: A total of 109 CytoSorb treatments were performed in 89 patients. A decrease in LDH (p=0.007), troponin T (p=0.022) and CPK (p=0.013) was reported during treatment. Vancomycin dose required significant adjustments during treatment (p<0.001), but no significant change was necessary after the first 3 days. Similarly, the requirements of bivalirudin significantly changed over days (p<0.001), but no dose adjustment was needed after the first 3 days of treatment. No differences in terms of vancomycin and bivalirudin dose need was observed between patients on extracorporeal membrane oxygenation to those who were or not (p=0.6 and p=0.6, respectively), between patients with and without continuous veno-venous hemofiltration (p=0.9 and p=0.9, respectively), and between CytoSorb responders or not (p=0.4 and p=0.7, respectively).

Conclusions: CytoSorb is effective in mitigating the systemic inflammatory response and safe with respect to vancomycin and bivalirudin administration. These preliminary data further support the use of CytoSorb as adjunct therapy in critically ill patients.