Association between Cytokine Adsorption Therapy and Organ Dysfunction Trajectories in Septic Shock with AKI: A Retrospective Cohort Study

INTRODUCTION: Septic shock with acute kidney injury (AKI) carries a high risk of mortality and multi-organ dysfunction. Cytokine adsorption therapy has been proposed as a potential adjunct to continuous renal replacement therapy. We aimed to evaluate the association between cytokine adsorption and short-term organ dysfunction as well as in-hospital mortality in patients treated with continuous veno-venous hemodiafiltration (CVVHDF). METHODS: This single-center retrospective cohort study included 73 adult patients with septic shock and AKI who underwent CVVHDF. Patients receiving additional cytokine adsorption therapy using the HA330 cartridge were compared with those receiving standard treatment. The primary outcome was 72-h change in SOFA score (ΔSOFA). Secondary outcomes included in-hospital mortality and hemodynamic trends. Multivariable logistic regression and Cox proportional hazards models were applied to adjust for confounding and assess survival. RESULTS: Cytokine adsorption therapy was associated with a significantly greater median ΔSOFA score (5.9 vs. 0.0; p < 0.001). In-hospital mortality was lower in the cytokine group (hazard ratio 0.46; 95% confidence interval: 0.23-0.92; p = 0.027). Logistic regression confirmed cytokine adsorption as an independent predictor of survival (OR = 0.006, p = 0.039). The model demonstrated excellent discrimination (ROC AUC = 0.930) with high sensitivity (97.7%) at the 0.5 threshold. Exploratory subgroup analyses suggested that membrane type and microbial profile may modify treatment response. CONCLUSION: In this retrospective cohort, cytokine adsorption therapy was independently associated with early improvements in organ dysfunction and reduced in-hospital mortality. These findings support its potential therapeutic role, but require confirmation in larger multicenter prospective trials.