The International, Prospective COSMOS (CytOSorb® TreatMent Of Critically Ill PatientS) Registry: Interim Results in Patients with Septic Shock

doi:10.1016/j.aicoj.2026.100052

Sepsis & infection

The International, Prospective COSMOS (CytOSorb® TreatMent Of Critically Ill PatientS) Registry: Interim Results in Patients with Septic Shock

Ann Intensive CarePublished 19 Mar 2026Prospective registry study

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Authors' conclusion

In this Registry, CytoSorb® therapy was associated with significant early clinical benefits in patients with septic shock, including hemodynamic stabilization and improved fluid balance.

Study context

Population: Critically ill patients with septic shock treated with CytoSorb hemoadsorption, 18 sites
Participants: 140 patients · 18 study sites

Exposure: Before vs after CytoSorb hemoadsorption
Outcome: IL-6 level

Methodological detailsinternational, multicentre, interim analysis, CytoSorb (CS) applied with kidney replacement therapy (KRT) (85%), standalone hemoperfusion (10%) or extracorporeal membrane oxygenation (ECMO) (5%); mean 2.8 ± 2.2 adsorbers per patient

International
Multicentre
Interim analysis
CS applied with KRT (85%), standalone hemoperfusion (10%) or ECMO (5%); mean 2.8 ± 2.2 adsorbers per patient

Main finding

As reported in the abstract

Before CS2,013median · IQR 219–39,988 · pg/mL

After CS108median · IQR 75–1,662 · pg/mL

P < 0.0001

Observational data: associations, not effects.

Further findings

Noradrenaline requirement

P < 0.0001

Before CSmedian 0.23 µg/kg/minIQR 0.09–0.43

After CSmedian 0.07 µg/kg/minIQR 0.02–0.22

Outcome	Before CS	After CS	P value
Fluid balanceMedian, mL	+1,386 (IQR −15–2,960)	+59 (IQR −738–1,614)	P < 0.0001
P/F ratioMedian	120 (IQR 70–208)	172 (IQR 114–257)	P = 0.0003
Overall SOFA scoreNo significant change			P = 0.65

Overall SOFA score

Respiratory, cardiovascular and renal SOFA sub-scores improved significantly; coagulation worsened

ICU mortality

Observed ICU mortality: 32.4%

Safety

Platelet count

P < 0.0001

Before CSmedian 123 ×109/LIQR 86–182

After CSmedian 66 ×109/LIQR 37–121

Serious adverse device effects or dysfunctions

No serious adverse device effects or dysfunctions reported

Original publication

The International, Prospective COSMOS (CytOSorb® TreatMent Of Critically Ill PatientS) Registry: Interim Results in Patients with Septic Shock. Ann Intensive Care. Published 19 March 2026. doi:10.1016/j.aicoj.2026.100052

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