Hemoadsorption therapy in severe rhabdomyolysis: a report from the international, prospective COSMOS (CytOSorb ^® TreatMent of Critically ill PatientS) registry

Severe rhabdomyolysis is associated with an increased risk of acute kidney injury (AKI) and mortality. Hemoadsorption may reduce myoglobin levels and mitigate AKI. The COSMOS registry is a prospective, multicenter, observational study evaluating hemoadsorption with CytoSorb^® (CS) in critically ill patients. Consecutive eligible patients are enrolled without preselection, and data collected at multiple timepoints: 24 h before CS; during CS and 24 h post-treatment; at ICU and at hospital discharge and at 90-day follow-up. The current analysis examined the effects of hemoadsorption in patients with severe rhabdomyolysis (e.g. myoglobin > 10,000 µg/L) by comparing changes in myoglobin and creatinine levels over time and the associated clinical impact. A total of 31 patients (mean age 55 years; 19% female) were included; CS was either integrated into renal replacement therapy (RRT) (<i>n</i> = 25, 81%) or used in stand-alone hemoperfusion mode (<i>n</i> = 6, 19%). When comparing pre- to post- CS treatment, significant reductions in mean myoglobin (24,109 ± 28,777 to 4,251 ± 4,399 µg/L; <i>p</i> = 0.001) and creatinine levels (3.5 ± 2.9 to 2.4 ± 1.5 mg/dL; <i>p</i> = 0.013) were observed. ICU mortality occurred in 8 (26%) patients. All survivors (<i>n</i> = 23) were able to be discharged from ICU without renal support. During the 90-day follow-up only one of these patients required dialysis again. Furthermore, there were no serious device-related adverse effects reported. The current study suggests that hemoadsorption is an effective method to rapidly and safely reduce myoglobin levels in severe rhabdomyolysis and may improve kidney function. These encouraging results will require validation in larger, controlled studies.