Cytosorbents Corporation · NASDAQ:CTSO
Cytosorbents — Technical Presentation (September 2025)
66 slides from Cytosorbents's technical presentation, Sep 29, 2025
Slide 1: Turning the Tide of Sepsis and Septic Shock: Real World Insights with CytoSorb
Turning the Tide of Sepsis and Septic Shock: Real World Insights with CytoSorb September 10, 2025 Link to webinar replay: https://cyto.news/webinar-sepsis/sep10 1 |
Slide 2: Purpose and Agenda
Purpose and Agenda In recognition of World Sepsis Day (September 13th) and Sepsis Awareness Month (September) and our commitment to help to solve the sepsis crisis: • Summarize the current understanding of how CytoSorb® broadly treats sepsis and septic shock • Help to optimize CytoSorb treatment wit
Slide 3: Participants
Participants Dr. Phillip Chan, MD, PhD - Moderator Chief Executive Officer – CytoSorbents Dr. med. Tobias Hübner, MD DESA EDIC MHBA Chief Physician of the Intensive Care Unit and Vice Head of the Department of Anesthesia and Intensive Care Hospital of Münsterlingen – Münsterlingen, Switzerland Prof.
Slide 4: The CytoSorb Adsorber
The CytoSorb Adsorber CytoSorb is a broad-spectrum blood purification device approved as the first specifically approved extracorporeal cytokine adsorber in the European Union in 2011 and used in more than 70 countries and nearly 300,000 human treatments worldwide. It is also approved to remove bili
Slide 5: CytoSorb Controls Massive Inflammation - the Heart of Critical Illness
CytoSorb Controls Massive Inflammation - the Heart of Critical Illness • Acute inflammation is the body’s mechanism to fight injury and infection • However, severe inflammation, driven by cytokine storm, can cause a chain reaction of problems that can end in organ failure and death CAPILLARY IMMUNE
Slide 6: Sepsis and Septic Shock are Deadly
Sepsis and Septic Shock are Deadly • Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. • This “dysregulated host response” often manifests as a worsening inflammatory response that can spiral out of control, fueled by the excessive productio
Slide 7: The Duality of Sepsis
The Duality of Sepsis For more than a decade, CytoSorbents has collaborated with clinicians and scientists around the world to advance the treatment of sepsis and septic shock by complementing traditional antibiotics with the broad-spectrum capability of CytoSorb CytoSorb treats the deadly inflammat
Slide 8: The Key to Success: Right Patient, Right Timing, Right Dosing
The Key to Success: Right Patient, Right Timing, Right Dosing Right Patient Just like antibiotics, CytoSorb works most effectively when: Highest Chance for • Treat Early Good • Treat Intensively Cinical Outcome • Compete the Full Course of Treatment Right Right Timing Dose 8 |
Slide 9: CytoSorb Attacks Sepsis in a Comprehensive & Multi-faceted Way
CytoSorb Attacks Sepsis in a Comprehensive & Multi-faceted Way Reduce inflammation by reducing a broad range of cytokines (cytokine storm) & other inflammatory mediators Bacterial toxins (hemolysins, super antigens, etc) Reversal of shock (macro) & improvement in microcirculation and lactate clearan
Slide 10: CytoSorb Core Treatment Goals
CytoSorb Core Treatment Goals A wealth of published, peer-reviewed studies support the broad mechanisms of action of CytoSorb that enable a comprehensive and multi-faceted attack on septic shock – from beginning to end CytoSorb helps to achieve the Core Treatment Goals in Septic Shock to Prevent or
Slide 11: Treatment Goal #1: Break the Vicious Cycle of Massive Uncontrolled Inflammation
CytoSorb Treatment Goal #1: Break the Vicious Cycle of Massive Uncontrolled Inflammation 11 | CytoSorbents Confidential Jansen, A., et al. Critical Care (2023)27:117
Slide 12: CytoSorb Broadly Reduces Inflammatory Mediators
CytoSorb Broadly Reduces Inflammatory Mediators In Vitro Adsorption of Cytokines from Blood In Vitro Adsorption of PAMPs from Blood In Vitro Adsorption of DAMPs from Blood % Remaining % Remaining % Remaining Minutes Minutes Minutes Cytokines Pathogen associated molecular Damage associated molecular
Slide 13: CytoSorb Blunts the Inflammatory Response
CytoSorb Blunts the Inflammatory Response In a well-controlled endotoxin-challenge model in 24 healthy human volunteers, CytoSorb treatment demonstrated a marked attenuation of cytokines compared to controls. Importantly, following repeat endotoxin challenge 1 week later (no blood purification), the
Slide 14: CytoSorb Treatment Goal #2: Stabilize the Patient
CytoSorb Treatment Goal #2: Stabilize the Patient 14 | CytoSorbents Confidential Jansen, A., et al. Critical Care (2023)27:117
Slide 15: CytoSorb Improves Microcirculation, Promotes Lactate Clearance
CytoSorb Improves Microcirculation, Promotes Lactate Clearance Normal Sepsis 15 | Courtesy of Prof. Can Ince, Department of Translational Intensive Care Medicine, Erasmus Medical Center, Rotterdam, Netherlands
Slide 16: CytoSorb Can Help Prevent Immune Cell Mediated Organ Injury
CytoSorb Can Help Prevent Immune Cell Mediated Organ Injury • Local chemokine expression and endothelial cell • In a cecal ligation puncture peritonitis sepsis adhesion molecules (ECAMs) are critical to rat model (n=76) without antibiotics, activated leukocyte recruitment to an area of CytoSorb trea
Slide 17: CytoSorb Enables Shock Reversal and Improved Fluid Balance
CytoSorb Enables Shock Reversal and Improved Fluid Balance Reversal of shock is a key feature of CytoSorb usage, resulting in the ability to wean vasopressors, restore both macro and microcirculation, reduce lactate, promote capillary leak reversal, and enable fluid removal Shock Reversal Improved F
Slide 18: 2025: COSMOS Registry Reaffirms Results in Real-World Setting
2025: COSMOS Registry Reaffirms Results in Real-World Setting COSMOS registry, patient characteristics CAPILLARY LUNG • Data from 150 patients analyzed SHOCK LEAK FUNCTION • Critical care indications: Septic shock (57.6%) Cardiogenic shock (12.9%) Rhabdomyolysis (10.6%) Acute/acute-on-chronic liver
Slide 19: CytoSorb Treatment Goal #3: Promote Repair of Capillary Leak
CytoSorb Treatment Goal #3: Promote Repair of Capillary Leak 19 | CytoSorbents Confidential Jansen, A., et al. Critical Care (2023)27:117
Slide 20: Capillary Leak Causes Organ Failure & Prevents Fluid Removal
Capillary Leak Causes Organ Failure & Prevents Fluid Removal Cytokine storm and other toxins cause damage to endothelial tight junctions and capillary leak syndrome. A reduction in cytokine storm through CytoSorb treatment helps to protect against this ongoing injury Cytokines Vasoactives (PAF, thro
Slide 21: CytoSorb Protects Against Capillary Leak Syndrome
CytoSorb Protects Against Capillary Leak Syndrome • A 32 yo woman was found unconscious and severely hypoxic from influenza pneumonia, and had ARDS on ECMO, septic shock, and acute kidney injury with a SOFA score = 18 • In spite of a broad anti-infective regimen, adequate fluid resuscitation, and hi
Slide 22: CytoSorb Removes Endothelial Toxic Substances
CytoSorb Removes Endothelial Toxic Substances Fractions that inhibit endothelial cell growth Fractions that kill endothelial cells 22 |
Slide 23: By Removing Toxic Insults, the Endothelium Can Now Heal
By Removing Toxic Insults, the Endothelium Can Now Heal • Healing of the endothelium, regeneration of the glycocalyx, and the reversal of capillary leak requires time on the order of days • Some healing will take place while on CytoSorb therapy. However, this healing is expected to continue AFTER Cy
Slide 24: Treatment Goal #4: Actively Remove Excessive Fluid
Treatment Goal #4: Actively Remove Excessive Fluid 24 | CytoSorbents Confidential Jansen, A., et al. Critical Care (2023)27:117
Slide 25: Removal of Excessive Fluid Can Help Organ Function
Removal of Excessive Fluid Can Help Organ Function Hypovolemic Congestive shock nephropathy • Weaning of vasopressors and a resolution of shock, and an improvement in capillary leak offers an ideal starting point for active fluid removal via CRRT or diuresis • Gradual fluid removal is recommended in
Slide 26: The Kidney is Like the Brain – Trapped in an Unexpandable Case
The Kidney is Like the Brain – Trapped in an Unexpandable Case • Sepsis-associated Acute Kidney Injury (S-AKI) occurs in an Fibrous Skull estimated 1 in 6 ICU patients with sepsis Renal • Severe S-AKI significantly increases the risk of mortality and Capsule poses major challenges in fluid balance,
Slide 27: Simple Way to Think about CytoSorb Therapy
Simple Way to Think about CytoSorb Therapy Right Patient Hyperinflamed with organ dysfunction/failure Right Timing Early intervention following standard of care Frequency Change device q8-q12h initially. As severity decreases, switch to q24h Right Dosing Flow Higher flow rate = higher blood volumes
Slide 28: Common Findings with CytoSorb Treatment
Common Findings with CytoSorb Treatment • Inflammatory marker reductions • IL-6 and other cytokines • PCT, CRP • Ferritin • Improved Hemodynamic stabilization • Decreased need for vasopressors • Stabilization of fluid balance • Decrease in lactate levels • Objective improvement in lung function (may
Slide 29: CytoSorb + ECMO for Severe ARDS May Enable Enhanced Lung Rest
CytoSorb + ECMO for Severe ARDS May Enable Enhanced Lung Rest CytoSorb, in combination with ECMO, represents a novel and potentially effective Enhanced Lung Rest strategy to treat severe ARDS Dr. Robert Bartlett - Pioneer of ECMO, and former CytoSorbents Chief Medical Officer for 10 years • ECMO pro
Slide 30: Early Use of CytoSorb + ECMO to Treat Severe ARDS
Early Use of CytoSorb + ECMO to Treat Severe ARDS • 13 patients prospectively enrolled with severe ARDS due to pneumonia and severe shock treated early with CytoSorb + ECMO (compared to ECMO only historical control; n=7) • Cause of pneumonia: 3 Influenza, 9 Bacterial, 1 Fungal vs 2 flu, 2 bacterial,
Slide 31: NYU Patient Intervention Timeline with CytoSorb + ECMO on First 4 COVID-19 Patients Pre-EUA
NYU Patient Intervention Timeline with CytoSorb + ECMO on First 4 COVID-19 Patients Pre-EUA Start Mech Start Mech Start Still on Vent Vent VV ECMO SC EC VV ECMO Start Mech Start Off Vent VV ECMO SC VV ECMO EC Start Mech Off Vent & VV SC EC VV ECMO ECMO Start Mech Off Vent & VV SC VV ECMO ECMO EC D0
Slide 32: CytoSorb Therapy in COVID-19 (CTC) Registry under FDA EUA
CytoSorb Therapy in COVID-19 (CTC) Registry under FDA EUA In the largest multi-center study in 100 consecutive critically ill COVID-19 patients with hyperinflammation and refractory respiratory failure treated with CytoSorb and ECMO: 1) Patient were treated with 72 hours of CytoSorb (q12h x 1 day, q
Slide 33: Early Treatment with CytoSorb Improves Outcome
Early Treatment with CytoSorb Improves Outcome Early treatment with ECMO and CytoSorb led to the best clinical outcomes, including less time on mechanical ventilation, ECMO, and in the ICU, a trend to lower need for vasopressors, and supports the concept of “enhanced lung rest” where ECMO reduces ve
Slide 34: 2025: Early & Intensive Treatment with More Blood Treated Works Best
2025: Early & Intensive Treatment with More Blood Treated Works Best • Large, retrospective single center study • 175 patients with septic shock treated with CytoSorb • Evaluated the impact of early versus late, and low versus high intensity treatment with CytoSorb on mortality compared to predicted
Slide 35: CytoSorb Improves Survival in Septic Shock Meta-Analysis
CytoSorb Improves Survival in Septic Shock Meta-Analysis • Meta-analysis of 744 septic shock patients from 1 RCT and 8 observational studies from 2019-2024, of which 449 patients were treated with CytoSorb • CytoSorb reduced in-hospital mortality (OR 0.64, p=0.04) • 28-30-day mortality was also halv
Slide 36: Summary
Summary • Massive uncontrolled inflammation can rapidly cause organ failure and death • Treating hyperinflammation requires patience • Right Patient Hyperinflamed with organ dysfunction/failure • Right Timing Early intervention following standard of care • Right Frequency Change device q12h initiall
Slide 37: CytoSorbents Corporation
CytoSorbents Corporation NASDAQ: CTSO Company Contact: Dr. Phillip Chan pchan@cytosorbents.com 908-307-0367 www.cytosorbents.com 37
Slide 38: Case of acute pancreatitis and septic shock
Case of acute pancreatitis and septic shock Prof. Dr. Zsolt Molnár, MD, PhD Head of Department of Anesthesiology and Intensive Therapy Semmelweis University – Budapest, Hungary Department of Anesthesiology and Intensive Therapy Prof. Dr. Zsolt Molnár
Slide 39: Initial event: acute pancreatitis
Initial event: acute pancreatitis • 36 year old male • Acute alcoholic pancreatitis • MOF for 2 weeks • IAP > 20 cmH2O • Laparotomy – open abdomen with VAC • Regular VAC exchanges • Perforated colon – Right hemicolectomy Department of Anesthesiology and Intensive Therapy Prof. Dr. Zsolt Molnár
Slide 40: 1 day before 3rd VAC exchange
1 day before 3rd VAC exchange Circulation Respiration Heart rate (min-1) 96 FiO2 40 MAP (mmHg) 72 PEEP (cmH2O) 13 ScvO2 (%) 75 PaO2 (mmHg) 98 Vasopressors - Inotropes - Renal function Inflammation Creat (umol/L) 73 UO (mL/h) 100-200 PCT (nmol/L) 0.61 pH 7.40 CRP (mmol/L) 312 HCO3 (mmol/L) 21.6 Lacta
Slide 41: During 3rd VAC exchange
During 3rd VAC exchange • Perforated cecum was found • Right hemicolectomy • Intra-operative course: – Increasing vasopressor need – Increased FiO2, PEEP Department of Anesthesiology and Intensive Therapy Prof. Dr. Zsolt Molnár
Slide 42: Before-after VAC exchange
Before-after VAC exchange Circulation Before After Respiration Before After Heart rate (min-1) 96 118 FiO2 40 80 MAP (mmHg) 72 68 PEEP (cmH2O) 13 28/6 ScvO2 (%) 75 78 PaO2 (mmHg) 98 91 Norepinephrine (ug/kg/min) -- 0.59 Vasopressin (NE/min) -- 0.02 DAMP, WhatPAMP happened? or both? Renal function In
Slide 43: Before-after 12 hrs CytoSorb treatment
Before-after 12 hrs CytoSorb treatment Circulation Before After Respiration Before After Heart rate (min-1) 118 95 FiO2 80 40 MAP (mmHg) 68 73 PEEP (vízcm) 28/6 16 ScvO2 (%) 78 72 PaO2 (Hgmm) 91 129 Norepinephrine (ug/kg/min) 0.59 0.07 Vasopressin (NE/min) 0.02 -- Improved P/F Reduced NE Renal funct
Slide 44: Take home message
Take home message • Surgery can trigger severe hyperinflammatory response • Early (<12 hrs) treatment seemed extremely effective Was it due to: - Source control? - ABs? - HA? - Patient himself? Department of Anesthesiology and Intensive Therapy Prof. Dr. Zsolt Molnár
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Slide 46: Case Reports and the Use of the CytoScore
Case Reports and the Use of the CytoScore Dr. med. Tobias Hübner, MD DESA EDIC MHBA Chief Physician of the Intensive Care Unit and Vice Head of the Department of Anesthesia and Intensive Care Hospital of Münsterlingen – Münsterlingen, Switzerland
Slide 47: The CytoScore Dynamic Scoring System
The CytoScore Dynamic Scoring System ?
Slide 48: Case 1: Urosepsis Case Report
Case 1: Urosepsis Case Report Example from our hospital Diagnosis Septic Start standard CytoScore after 6h: shock Start CytoSorb therapy (Urosepsis) (Started in ED) 6 within next 1 hour • Lactate 3.9 mmol/l • Lactate 0.8 mmol/l • NE 0.25 µg/kg/min • NE 0.1 µg/kg/min • Dbt 1.5 µg/kg/min • Volume ther
Slide 49: Example from our hospital
Example from our hospital Time
Slide 50: Case 2: Abdominal Septic Shock
Case 2: Abdominal Septic Shock Example from our hospital Diagnosis Septic Start standard CytoScore after 6hrs shock Start CytoSorb therapy (Abdominal Sepsis) (Started in OT) >8 within next 36 hrs • Lactate 7.0 mmol/l • NE 0.55 µg/kg/min • Lactate 3 mmol/l • NE 0.2 µg/kg/min • Dbt 1.5 µg/kg/min • Hyd
Slide 51: Example from our hospital
Example from our hospital Time
Slide 52: Validation
Validation Final remarks still to be done Past Present Future CytoScore is a decision- making tool to start with CS. CytoScore is NOT a monitoring tool for effectiveness of CytoSorb therapy!
Slide 53: Final remarks
Final remarks • CytoScore can be established at any ICU in the world • It can be easily integrated in daily routine • No need for new devices • CytoScore is helping to do the right thing at the right moment
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Slide 55: Case and local approach from Arnsberg
Case and local approach from Arnsberg Priv.-Doz. Dr. med. Kevin Pilarczyk, MHBA 55 |
Slide 56: HIT HARD AND EARLY !!!!
HIT HARD AND EARLY !!!! When to start ??? When to change??? How much blood flow ??? 56 |
Slide 57: CytoSorb in septic shock- Arnsberg approach ?
CytoSorb in septic shock- Arnsberg approach ? Septic shock No hemodynamic stabilization within 6 h Indication CytoSorb ? ✓ NE > 0.25 µg/kgBW/min ✓ Lactate > 3mmol/l o. rising ✓ IL-6 > 500 pg/ml ✓ (PCT elevated ) ✓ CytoScore after 6 h > 6 START CYTOSORB (BEFORE onset AKI) Stabilization, NE < 0.05 µg/
Slide 58: CytoSorb in septic shock
CytoSorb in septic shock Too early !!! • Normal lactate • NE < 0.2 µg/kgBW/min. • No fluid bolus • Onset septic shock < 3 h Just right !!! • Lactate > 3-4 mg/dl • NE 0.25-0.3 µg/kgBW/min. • Multiple fluid boluses • Onset of septic schock < 6 h Too late !!! • Lactate > 7.5 mg/dl • NE > 0.8 µg/kgBW/mi
Slide 59: CytoSorb: Sepsis and beyond…
CytoSorb Sepsis and beyond… Sepsis, ARDS, CS Rhabdo- Liver vasoplegia MCS myolysis failure 59 |
Slide 60: Case 1
Case 1 6 a.m. call from external hospital (distance 140 km): • Male patient, 35 years old, severe ARDS, pneumonia • No comorbidities • Current paO2/FiO2 45 mmHg. • Hemodynamically unstable, NE 1.2 µg/kgBW/min, lactate 8 mg/dl. Start at 6:10 a.m. Estimated time with car 2h 15min Switch to helicopter
Slide 61: ae Cytosorbents.
61 ae Cytosorbents. eee
Slide 62: Case 1
Case 1 Status on arrival MAP 55 mmHg, SR 140/min, Lactate 12 mg/dl, pH 7.0 Mottling 3, NE 1.8 µg/kgBW/min. Echo: severe septic cardiomyopathy, SV 18 ml, CPO = 0.32 Watt Pressure controlled, FiO2 1.0, PEEP 20 mbar, Pinsp 50 mbar, RR 24/min, VT = 9 ml/kgBW, SpO2 33 %, paO2 36 mmHg, pCO2 65 mmHg No diu
Slide 63: MCS therapy
MCS therapy Veno 19 Fr Arterio Venous d 25 Fr 17 Fr17 Fr 63 |
Slide 64: Case 1
Case 1 Further course ✓ AKI with CRRT, liver failure, rhabdomyolsis ✓ Hemodynamic improvemevent within 5 days ✓ VA-ECMO-weaning with Levosimendan, De-escalation vv-ECMO day 6 + Impella explantation day 8 ✓ PDT on day 9, vv-ECMO decannulation on day 18 64 |
Slide 65: Effects of Cytosorb
Effects of Cytosorb BILLIRUBINE [MG/DL] 18 15 15 12 12 11 10 day 1 day 2 day 3 day 4 day 5 day 6 day 7 MYOGLOBINE [ΜG/L] 44000 32000 18000 12000 7000 4000 3000 65 | day 1 day 2 day 3 day 4 day 5 day 6 day 7
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