ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1670620
This article is part of the Research TopicExtracorporeal Organ Support: Innovations and Challenges in Critical CareView all 9 articles
Interleukin-6 extraction ratios during prolonged Cytosorb hemoadsorption depend on procedure blood flow
Provisionally accepted
- University Medical Centre Ljubljana, Ljubljana, Slovenia
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background. Hemoadsorption with Cytosorb is a novel treatment for cytokine release syndrome, but there are few published data on the rate of cytokine removal with prolonged use. We report a prospective observational study on IL-6 extraction ratios with prolonged Cytosorb use. Methods. A secondary analysis of a prospective observational cohort study in patients treated with Cytosorb. Blood samples for IL-6 were taken before treatment, after 30 minutes and then every 6 hours of treatment at three sites: 1) before adsorber, 2) between adsorber and dialyzer and 3) after dialyzer. The extraction ratios over adsorber were calculated. Results. We included 21 dialysis circuits performed in 15 critically ill patients, mainly with cytokine storm due to septic shock. Median extraction ratio of IL-6 after 30 minutes was 26% (inter-quartile range 18-37%). Ratio decreased to 10% (6-21%) after 6 hours and remained between 9-16% for up to 24 hours (with low number of circuits used beyond 12 hours). Extraction ratios were similar in circuits with high (>1,000 ng/L) and low baseline IL-6 levels. On the contrary, in circuits with high blood flow (>=200 mL/min, i.e. intermittent hemodialysis) the extraction ratio was very low (median 6%) at 6 hours and negligible thereafter, while the circuits with lower blood flow (<200 ml/min) maintained extraction ratio at 20% for up to 12 hours. Conclusions. We observed a significant reduction of IL-6 extraction ratio within 6 hours in circuits with high blood flow, while circuits with lower blood flow maintained adequate extraction ratio for up to 12 hours. Recent consensus recommendations on 8-12 hours exchange interval should mainly be applied to continuous dialysis methods, while in intermittent hemodialysis the exchanges should be more frequent.
Keywords: interleukin 6 (IL6), Cytokines, CytoSorb, Hemoadsorption, Reduction ratio, removal rate
Received: 21 Jul 2025; Accepted: 25 Sep 2025.
Copyright: © 2025 Gubensek, Vajdic Trampuz, Zrimsek and Persic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jakob Gubensek, jakob.gubensek@kclj.si
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.