Adjuvant Hemadsorption Therapy in the Management of Refractory Septic Shock

Background Sepsis and septic shock remain global healthcare challenges, with mortality reaching up to 80% upon progression to refractory septic shock (RSS) and multi-organ dysfunction (MOD). A dysregulated immune response, characterized by a cytokine storm, is associated with increased mortality. This study evaluated the effectiveness of early hemadsorption to remove inflammatory mediators on survival and hospitalization duration in patients with RSS. Materials and Methods This retrospective study included 112 patients with refractory septic shock (RSS) treated with hemadsorption. Patients were divided into early (<24 hours) and late (≥24 hours) initiation groups, based on the timing of hemadsorption therapy after refractory shock onset. Four commercially available cytokine/endotoxin removal filters were used. Demographic, clinical, and laboratory parameters, comorbidities, and disease severity indices were analyzed. Mortality rates, length of intensive care unit (ICU) and hospital stays, and vasopressor requirements were compared between the two groups. Results The early initiation group showed significantly higher survival compared to the late group (n=27, 25.93% vs. n=85, 10.59%; p =0.032). Patients receiving hemadsorption therapy within 24 hours had significantly shorter ICU ( p =0.017) and hospital ( p =0.036) stays than those receiving hemadsorption at/after 24 hours. Procalcitonin and IL-6 levels significantly reduced post-hemadsorption, with the early initiation group showing more pronounced improvements. Conclusion Early adjuvant hemadsorption therapy within 24 hours of RSS onset improved patient outcomes, showing survival benefits and shorter hospital stays compared to delayed initiation.