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细胞因子血液吸附治疗脓毒症患者:系统评价和荟萃分析。

Cytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis.

机构信息

Universidad Científica del Sur - Lima, Peru.

Hospital Nacional Dos de Mayo - Lima, Peru.

出版信息

Crit Care Sci. 2023 Apr-Jun;35(2):217-225. doi: 10.5935/2965-2774.20230289-en.

Abstract

OBJECTIVE

To analyze the effect of CytoSorb® on mortality, interleukin levels, vasopressor use and adverse events in patients with sepsis.

METHODS

We searched MEDLINE®, Embase and the Cochrane Library for randomized controlled trials and cohort studies that reported the use of CytoSorb® among septic patients. The primary outcome was mortality, and secondary outcomes included the use of vasopressors, levels of inflammatory markers, predicted versus observed mortality, length of stay in the intensive care unit, and adverse events.

RESULTS

We included 6 studies enrolling 413 patients, and assessment for risk of bias indicated variations in study quality from high to moderate. The overall mortality rate was 45%, and no significant effect on mortality was found at 28 - 30 days (RR 0.98 [0.12 - 8.25] for the randomized clinical trial and RR 0.74 [0.49 - 1.13] for cohort studies). We did not perform a metanalysis for other outcomes due to the small number of studies found or the lack of data.

CONCLUSION

Our study found very low certainty evidence, due to imprecision, risk of bias, and heterogeneity, thereby showing no benefit of CytoSorb® use in terms of mortality at 28 - 30 days. We cannot recommend the use of CytoSorb® in septic or septic shock patients outside clinical trials. Further high-quality randomized trials with a common intervention arm are needed to evaluate the influence of CytoSorb® in this population.

PROSPERO REGISTER

CRD42021262219.

摘要

目的

分析 CytoSorb® 对脓毒症患者死亡率、白细胞介素水平、血管加压素使用和不良事件的影响。

方法

我们在 MEDLINE®、Embase 和 Cochrane 图书馆中搜索了报告使用 CytoSorb®治疗脓毒症患者的随机对照试验和队列研究。主要结局是死亡率,次要结局包括血管加压素的使用、炎症标志物水平、预测死亡率与观察死亡率的差异、重症监护病房住院时间和不良事件。

结果

我们纳入了 6 项研究,共纳入 413 名患者,评估偏倚风险表明研究质量从高到中等存在差异。总的死亡率为 45%,在 28-30 天没有发现对死亡率有显著影响(随机临床试验的 RR 0.98[0.12-8.25]和队列研究的 RR 0.74[0.49-1.13])。由于研究数量较少或缺乏数据,我们没有对其他结局进行荟萃分析。

结论

由于不精确、偏倚风险和异质性,我们的研究发现了非常低确定性证据,表明在 28-30 天时使用 CytoSorb®在死亡率方面没有获益。我们不能推荐在临床试验之外在脓毒症或脓毒性休克患者中使用 CytoSorb®。需要进一步开展具有共同干预措施的高质量随机试验,以评估 CytoSorb®在这一人群中的影响。

PROSPERO 注册号:CRD42021262219。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4efc/10406402/40ab9bd8d866/ccsci-35-02-0217-g01.jpg

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