{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T23:34:38Z","timestamp":1784158478724,"version":"3.55.0"},"reference-count":43,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Pro- and anti-inflammatory cytokines help regulate the inflammatory response. A cytokine storm is a dysregulated cytokine response associated with sepsis and other conditions that result in a hyper-inflammatory state. Extracorporeal cytokine adsorption has the potential to restore a balanced inflammatory response. Hemoperfusion with CytoSorb\u00ae (CS) appears to be a short-term mode of treatment of sepsis in both adults and children. Objective: We present a case series of eight critically ill children involving the use of hemoperfusion with CS at the University Medical Center Ljubljana to treat clinically manifested cytokine storm. Results: In our preliminary experience, it was applied without complication in five children weighing more than 10 kg, who all survived. The effect of age on complications regarding CS treatment is unclear, yet in our case series, all three patients weighing less than 10 kg died of their disease. Conclusions: In our preliminary experience, cytokine adsorption with CS remains a potential adjunctive treatment for cytokine storm in critically ill children.<\/jats:p>","DOI":"10.3390\/jcm13216587","type":"journal-article","created":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T11:53:43Z","timestamp":1730462023000},"page":"6587","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Hemoperfusion with CytoSorb\u00ae in Pediatric Patients: A Monocentric Case Series"],"prefix":"10.3390","volume":"13","author":[{"given":"Eva","family":"Rihar","sequence":"first","affiliation":[{"name":"University Children\u2019s Hospital, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanja","family":"Per\u0161i\u010d","sequence":"additional","affiliation":[{"name":"Center for Acute and Complicated Dialysis and Vascular Access, Department of Nephrology, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9891-7500","authenticated-orcid":false,"given":"Alexander","family":"Jerman","sequence":"additional","affiliation":[{"name":"Center for Acute and Complicated Dialysis and Vascular Access, Department of Nephrology, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Plankar Srovin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gorazd","family":"Mlakar","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, University Children\u2019s Hospital, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neva","family":"Bezeljak","sequence":"additional","affiliation":[{"name":"Center for Acute and Complicated Dialysis and Vascular Access, Department of Nephrology, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Pokorn","sequence":"additional","affiliation":[{"name":"University Children\u2019s Hospital, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0983-9366","authenticated-orcid":false,"given":"Petja","family":"Fister","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Department of Pediatric Intensive Care, University Children\u2019s Hospital, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1159\/000492379","article-title":"Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review","volume":"46","author":"Bonavia","year":"2018","journal-title":"Blood Purif."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1159\/000493523","article-title":"A New Series of Sorbent Devices for Multiple Clinical Purposes: Current Evidence and Future Directions","volume":"47","author":"Ankawi","year":"2019","journal-title":"Blood Purif."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1186\/cc9411","article-title":"Clinical review: Blood purification for sepsis","volume":"15","author":"Rimmele","year":"2011","journal-title":"Crit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jarczak, D., and Nierhaus, A. (2022). Cytokine Storm\u2014Definition, Causes, and Implications. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms231911740"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Nakamori, Y., Park, E.J., and Shimaoka, M. (2020). Immune Deregulation in Sepsis and Septic Shock: Reversing Immune Paralysis by Targeting PD-1\/PD-L1 Pathway. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.624279"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2594","DOI":"10.1001\/jama.2011.1829","article-title":"Immunosuppression in patients who die of sepsis and multiple organ failure","volume":"306","author":"Boomer","year":"2011","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1053\/j.jvca.2018.08.213","article-title":"Bilirubin Removal Using CytoSorb Filter in a Cardiac Surgical Patient","volume":"33","author":"Singh","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s13054-021-03468-x","article-title":"Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis","volume":"25","author":"Scharf","year":"2021","journal-title":"Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Schaedler, D., Pausch, C., Heise, D., Meier-Hellmann, A., Brederlau, J., Weiler, N., Marx, G., Putensen, C., Spies, C., and Jorres, A. (2017). The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0187015"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1001\/archinte.167.15.1655","article-title":"Understanding the inflammatory cytokine response in pneumonia and sepsis: Results of the Genetic and Inflammatory Markers of Sepsis (GenIMS) Study","volume":"167","author":"Kellum","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1159\/000500013","article-title":"What Have We Learned about the Use of Cytosorb Adsorption Columns?","volume":"48","author":"Ankawi","year":"2019","journal-title":"Blood Purif."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Persic, V., Jerman, A., Malgaj Vrecko, M., Berden, J., Gorjup, V., Stecher, A., Lukic, M., Jereb, M., Taleska Stupica, G., and Gubensek, J. (2022). Effect of CytoSorb Coupled with Hemodialysis on Interleukin-6 and Hemodynamic Parameters in Patients with Systemic Inflammatory Response Syndrome: A Retrospective Cohort Study. J. Clin. Med., 11.","DOI":"10.21203\/rs.3.rs-1600509\/v1"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s13613-019-0530-y","article-title":"Cytokine removal in human septic shock: Where are we and where are we going?","volume":"9","author":"Honore","year":"2019","journal-title":"Ann. Intensive Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e0688","DOI":"10.1097\/CCE.0000000000000688","article-title":"Mechanistic Considerations and Pharmacokinetic Implications on Concomitant Drug Administration During CytoSorb Therapy","volume":"4","author":"Scheier","year":"2022","journal-title":"Crit. Care Explor."},{"key":"ref_15","first-page":"ivae050","article-title":"Impact of intraoperative haemoadsorption on outcomes of patients undergoing aortic surgery: A single-centre, prospective, observational study","volume":"38","author":"Mehta","year":"2024","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E101","DOI":"10.1111\/aor.13864","article-title":"Continuous renal replacement therapy with the addition of CytoSorb cartridge in critically ill patients with COVID-19 plus acute kidney injury: A case-series","volume":"45","author":"Alharthy","year":"2021","journal-title":"Artif. Organs"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s13054-017-1662-9","article-title":"Hemoadsorption by CytoSorb in septic patients: A case series","volume":"21","author":"Kogelmann","year":"2017","journal-title":"Crit. Care"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bottari, G., Guzzo, I., Cappoli, A., Labbadia, R., Perdichizzi, S., Serpe, C., Creteur, J., Cecchetti, C., and Taccone, F.S. (2023). Impact of CytoSorb and CKRT on hemodynamics in pediatric patients with septic shock: The PedCyto study. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1259384"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1177\/0391398820902469","article-title":"Hemoperfusion with Cytosorb in pediatric patients with septic shock: A retrospective observational study","volume":"43","author":"Bottari","year":"2020","journal-title":"Int. J. Artif. Organs"},{"key":"ref_20","first-page":"819","article-title":"Immunoadsorption therapy for a meningococcemia patient with myocarditis, adrenal hemorrhage, and purpura fulminans: A case report","volume":"72","author":"Akcay","year":"2022","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1111\/aor.14047","article-title":"Hemadsorption as rescue therapy for patients with multisystem organ failure in pediatric intensive care-Report of two cases reports and review of the literature","volume":"45","author":"Steurer","year":"2021","journal-title":"Artif. Organs"},{"key":"ref_22","first-page":"3818407","article-title":"Use of Hemadsorption in a Case of Pediatric Toxic Shock Syndrome","volume":"2017","author":"Berkes","year":"2017","journal-title":"Case Rep. Crit. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"34","DOI":"10.11648\/j.ajp.20190502.11","article-title":"Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series","volume":"5","author":"Milella","year":"2019","journal-title":"Am. J. Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1177\/0391398818819953","article-title":"First successful hemoadsorption using CytoSorb\u00ae in a septic pediatric patient in Kazakhstan: A case report","volume":"42","author":"Saparov","year":"2019","journal-title":"Int. J. Artif. Organs"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1177\/0391398819858174","article-title":"Successful application of CytoSorb\u00ae hemadsorption in an immunocompromised teenager with collapsing glomerulopathy, acute respiratory distress syndrome, and sepsis","volume":"42","author":"Keles","year":"2019","journal-title":"Int. J. Artif. Organs"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"456","DOI":"10.3390\/epidemiologia5030032","article-title":"The Global Burden of Sepsis and Septic Shock","volume":"5","author":"Sangiorgio","year":"2024","journal-title":"Epidemiologia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s40124-023-00286-3","article-title":"Pediatric Sepsis: A Summary of Current Definitions and Management Recommendations","volume":"11","author":"Miranda","year":"2023","journal-title":"Curr. Pediatr. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1097\/PCC.0000000000001191","article-title":"Validation of the Vasoactive-Inotropic Score in Pediatric Sepsis","volume":"18","author":"McIntosh","year":"2017","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1542\/peds.91.3.617","article-title":"Score for Neonatal Acute Physiology: A physiologic severity index for neonatal intensive care","volume":"91","author":"Richardson","year":"1993","journal-title":"Pediatrics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1097\/PCC.0b013e31829760cf","article-title":"Paediatric index of mortality 3: An updated model for predicting mortality in pediatric intensive care*","volume":"14","author":"Straney","year":"2013","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1159\/000517471","article-title":"Hemoperfusion with CytoSorb to Manage Multiorgan Dysfunction in the Spectrum of Hemophagocytic Lymphohistiocytosis Syndrome in Critically Ill Children","volume":"51","author":"Bottari","year":"2021","journal-title":"Blood Purif."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Bottari, G., Confalone, V., Cotugno, N., Guzzo, I., Perdichizzi, S., Manno, E.C., Stoppa, F., and Cecchetti, C. (2021). Efficacy of CytoSorb in a Pediatric Case of Severe Multisystem Infammatory Syndrome (MIS-C): A Clinical Case Report. Front. Pediatr., 9.","DOI":"10.3389\/fped.2021.676298"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1177\/03913988211073812","article-title":"Effects of the timing and intensity of treatment on septic shock patients treated with CytoSorb\u00ae: Clinical experience","volume":"45","author":"Berlot","year":"2022","journal-title":"Int. J. Artif. Organs"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s00467-003-1342-7","article-title":"Renal replacement therapy for acute renal failure in children: European guidelines","volume":"19","author":"Strazdins","year":"2004","journal-title":"Pediatr. Nephrol."},{"key":"ref_35","first-page":"6987167","article-title":"Hemadsorption with Adult CytoSorb\u00ae in a Low Weight Pediatric Case","volume":"2017","author":"Cirstoveanu","year":"2017","journal-title":"Case Rep. Crit. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1177\/0391398819837539","article-title":"CytoSorb\u00ae hemoadsorption and mechanical circulatory support in a newborn with refractory shock after congenital heart surgery","volume":"42","author":"Perez","year":"2019","journal-title":"Int. J. Artif. Organs"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e0071","DOI":"10.1097\/CCE.0000000000000071","article-title":"Multimodal Therapeutic Approach of Cytokine Release Syndrome Developing in a Child Given Chimeric Antigen Receptor-Modified T Cell Infusion","volume":"2","author":"Bottari","year":"2020","journal-title":"Crit. Care Explor."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1007\/s13312-019-1661-9","article-title":"Cytosorb for Management of Acute Kidney Injury due to Rhabdomyolysis in a Child","volume":"56","author":"Padiyar","year":"2019","journal-title":"Indian. Pediatr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1177\/03913988221116135","article-title":"The successful application of hemoadsorption for extracorporeal liver support in a child with acute liver failure","volume":"45","author":"Hui","year":"2022","journal-title":"Int. J. Artif. Organs"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Rugg, C., Klose, R., Hornung, R., Innerhofer, N., Bachler, M., Schmid, S., Fries, D., and Strohle, M. (2020). Hemoadsorption with CytoSorb in Septic Shock Reduces Catecholamine Requirements and In-Hospital Mortality: A Single-Center Retrospective G\u2018enetic\u2019 Matched Analysis. Biomedicines, 8.","DOI":"10.3390\/biomedicines8120539"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1159\/000502540","article-title":"Changes in Cytokines, Haemodynamics and Microcirculation in Patients with Sepsis\/Septic Shock Undergoing Continuous Renal Replacement Therapy and Blood Purification with CytoSorb","volume":"49","author":"Zuccari","year":"2020","journal-title":"Blood Purif."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1159\/000369377","article-title":"Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter in Patients with Septic Shock: A Preliminary Report","volume":"38","author":"Shiga","year":"2014","journal-title":"Blood Purif."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1186\/s13054-016-1570-4","article-title":"The inflammatory response to extracorporeal membrane oxygenation (ECMO): A review of the pathophysiology","volume":"20","author":"Millar","year":"2016","journal-title":"Crit. Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6587\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:26:55Z","timestamp":1760113615000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6587"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,1]]},"references-count":43,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13216587"],"URL":"https:\/\/doi.org\/10.3390\/jcm13216587","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,1]]}}}