Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
Front Immunol. 2023 Jan 31;14:1067214. doi: 10.3389/fimmu.2023.1067214. eCollection 2023.
After its approval by the European Union in 2011, CytoSorb therapy has been applied to control cytokine storm and lower the increased levels of cytokines and other inflammatory mediators in blood. However, the efficiency of this CytoSorb treatment in patients with coronavirus disease (COVID-19) still remains unclear. To elucidate the Cytosorb efficiency, we conducted a systematic review and single-arm proportion meta-analysis to combine all evidence available in the published literature to date, so that this comprehensive knowledge can guide clinical decision-making and future research.
The literature published within the period 1 December 2019 to 31 December 2021 and stored in the Cochrane Library, Embase, PubMed, and International Clinical Trials Registry Platform (ICTRP) was searched for all relevant studies including the cases where COVID-19 patients were treated with CytoSorb. We performed random-effects meta-analyses by R software (3.6.1) and used the Joanna Briggs Institute checklist to assess the risk of bias. Both categorical and continuous variables were presented with 95% confidence intervals (CIs) as pooled proportions for categorical variables and pooled means for continuous outcomes.
We included 14 studies with 241 COVID-19 patients treated with CytoSorb hemadsorption. Our findings reveal that for COVID-19 patients receiving CytoSorb treatment, the combined in-hospital mortality was 42.1% (95% CI 29.5-54.6%, I = 74%). The pooled incidence of adjunctive extracorporeal membrane oxygenation (ECMO) support was 73.2%. Both the C-reactive protein (CRP) and interleukin-6 (IL-6) levels decreased after CytoSorb treatment. The pooled mean of the CRP level decreased from 147.55 (95% CI 91.14-203.96) to 92.36 mg/L (95% CI 46.74-137.98), while that of IL-6 decreased from 339.49 (95% CI 164.35-514.63) to 168.83 pg/mL (95% CI 82.22-255.45).
The majority of the COVID-19 patients treated with CytoSorb received ECMO support. In-hospital mortality was 42.1% for the COVID-19 patients who had CytoSorb treatment. Both CRP and IL-6 levels decreased after Cytosorb treatment.
2011 年，在欧盟批准后，细胞吸附疗法已被用于控制细胞因子风暴，并降低血液中细胞因子和其他炎症介质的升高水平。然而，这种细胞吸附治疗在冠状病毒病（COVID-19）患者中的疗效仍不清楚。为了阐明细胞吸附的疗效，我们进行了系统评价和单臂比例荟萃分析，以结合迄今为止发表文献中所有可用的证据，以便这些综合知识可以指导临床决策和未来的研究。
检索 2019 年 12 月 1 日至 2021 年 12 月 31 日期间在 Cochrane 图书馆、Embase、PubMed 和国际临床试验注册平台（ICTRP）中发表的所有相关研究，包括使用细胞吸附治疗 COVID-19 患者的病例。我们使用 R 软件（3.6.1）进行随机效应荟萃分析，并使用 Joanna Briggs 研究所检查表评估偏倚风险。分类变量和连续变量均以 95%置信区间（CI）表示，分类变量为汇总比例，连续结局为汇总均值。
我们纳入了 14 项研究，共 241 例 COVID-19 患者接受了细胞吸附血液吸附治疗。我们的研究结果表明，对于接受细胞吸附治疗的 COVID-19 患者，住院死亡率为 42.1%（95%CI 29.5-54.6%，I=74%）。辅助体外膜肺氧合（ECMO）支持的累积发生率为 73.2%。细胞吸附治疗后 C 反应蛋白（CRP）和白细胞介素 6（IL-6）水平均降低。CRP 水平的汇总均值从 147.55（95%CI 91.14-203.96）降至 92.36mg/L（95%CI 46.74-137.98），IL-6 水平从 339.49（95%CI 164.35-514.63）降至 168.83pg/mL（95%CI 82.22-255.45）。
接受细胞吸附治疗的 COVID-19 患者多数接受了 ECMO 支持。接受细胞吸附治疗的 COVID-19 患者的住院死亡率为 42.1%。细胞吸附治疗后 CRP 和 IL-6 水平均降低。
