Analysis of Trends and Influencing Factors of Cytokine-Adsorbing Therapies: A Nationwide Ecological Study in Japan.

BACKGROUND

Cytokine-adsorption therapy has garnered attention as a potential treatment for conditions such as sepsis, although supporting evidence remains limited. Consequently, its utilization is expected to vary significantly across regions. To date, no ecological studies have investigated this regional heterogeneity.

OBJECTIVE

This study aimed to examine temporal trends in the use of continuous renal replacement therapy (CRRT) with cytokine-adsorbing hemofilters and polymyxin-B immobilized fiber-direct hemoperfusion (PMX-DHP), as well as the spatial distribution of both across Japan's 47 prefectures.

METHODS

This ecological study analyzed National Database (NDB) open data. A longitudinal analysis from 2016 to 2022 assessed temporal trends in the use of adsorption membranes. A cross-sectional analysis of the 2022 data utilized Moran's I statistic to evaluate the spatial autocorrelation of adsorption therapy. To examine the relationship between the two types of adsorption therapy, we calculated the Pearson correlation coefficient and conducted a multivariate analysis.

RESULTS

The longitudinal analysis revealed no significant change in the proportion of cytokine-adsorbing hemofilter use, while PMX-DHP use showed a decreasing trend over the seven-year period. Cross-sectional analysis indicated spatial autocorrelation for both PMX-DHP (Moran's I: 0.34, P < 0.001) and cytokine-adsorption filter use (Moran's I: 0.24, P < 0.001). Univariate analysis (R = -0.29, P = 0.0453) and multivariate analysis (estimated coefficient: 1.27, 95% CI: 0.06-2.49, P = 0.045) demonstrated that higher usage rates of cytokine-adsorbing blood filters were associated with higher PMX-DHP usage rates.

CONCLUSIONS

This study identified a declining trend in PMX-DHP use and an association between PMX-DHP and cytokine-adsorbing hemofilter utilization. These findings suggest that physicians' preferences and perceptions regarding cytokine-adsorption therapy may influence its use. Further research with individual patient data is warranted to confirm these findings.