Cytokine adsorption in patients with acute‐on‐chronic liver failure (CYTOHEP) — Aasingle center, open‐label, three‐arm, randomized, controlled intervention pilot trial

Abstract: Background
To investigate the efficacy of bilirubin reduction by hemoadsorption with CytoSorb® in patients with acute-on-chronic liver failure (ACLF) receiving continuous renal replacement therapy (CRRT).

Methods
A prospective, randomized, single-center, open-label, controlled pilot trial. Patients with ACLF, acute kidney injury, and serum bilirubin ≥5 mg/dL were assigned 1:1:1 to one of three study groups (CRRT with or without hemoadsorption, no CRRT). In the hemoadsorption group, the CytoSorb adsorber was incorporated into the CRRT system, replaced after 12, 24, and 48 h, and removed after 72 h. The primary endpoint was the serum bilirubin level after 72 h.

Results
CYTOHEP was terminated early due to difficulties in recruiting patients and ethical concerns. Three of 9 patients (33%) were treated in each group. Comparing the three groups, mean bilirubin levels after 72 h were lower by −8.0 mg/dL in the “CRRT with hemoadsorption” group compared to “CRRT without hemoadsorption” (95% CI, −21.3 to 5.3 mg/dL; p = 0.17). The corresponding mean difference between “CRRT without hemoadsorption” and “no CRRT” was −1.4 mg/dL (95% CI, −14.2 to 11.5 mg/dL; p = 0.78). Comparing “CRRT with hemoadsorption” and “no CRRT,” it was −9.4 mg/dL (95% CI, −20.8 to 2.1 mg/dL; p = 0.0854). Only 1/9 patients (11%, “no CRRT” group) survived day 30 after study inclusion but died on day 89. IL-6, liver function parameters, and clinical scores were similar between the study groups.

Conclusions
CYTOHEP failed to demonstrate that extracorporeal hemoadsorption combined with CRRT can reduce serum bilirubin in ACLF patients with acute kidney failure

Object Details

• Location: Deutsche Nationalbibliothek Frankfurt am Main
• Extent: Online-Ressource
• Language: Englisch
• Notes: Artificial organs. - 48, 10 (2024) , 1150-1161, ISSN: 1525-1594

Contributors, Places and Time

• Event: Veröffentlichung
• (where): Freiburg
• (who): Universität
• (when): 2024
• Creator: Sekandarzad, Asieb ; Graf, Erika ; Prager, Eric Peter ; Luxenburger, Hendrik ; Staudacher, Dawid ; Wengenmayer, Tobias ; Bettinger, Dominik ; Supady, Alexander

Further information

• DOI: 10.1111/aor.14774
• URN: urn:nbn:de:bsz:25-freidok-2491258
• Rights: Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Last update: 25.03.2025, 1:42 PM CET