Orban Carmen, Bratu Angelica, Agapie Mihaela, Borjog Tudor, Jafal Mugurel, Sima Romina-Marina, Dumitrașcu Oana Clementina, Popescu Mihai
Obstetrics and Gynecology, Anesthesia and Intensive Care, Department 14, School of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania.
Bucharest University Emergency Hospital, 169 Splaiul Independentei, 050098 Bucharest, Romania.
Biomedicines. 2025 Jan 13;13(1):180. doi: 10.3390/biomedicines13010180.
Severe inflammation leading to organ dysfunction is the cornerstone of the pathophysiology of sepsis. Thus, from a theoretical point of view, rebalancing inflammation has the potential to improve patient outcomes.
To better understand the clinical effectiveness of hemoadsorption in managing inflammation, we conducted an updated meta-analysis on the effects of CytoSorb in critically ill septic patients. Ten studies containing 715 patients (355 in the interventional group and 360 in the control group) have been included in the final analysis.
Statistical analysis demonstrated that the use of CytoSorb did not influence overall mortality (OR 0.95, 95% CI [0.58, 1.56], = 0.85), but we observed a decreased mortality when comparing CytoSorb-treated patients with patients in the control group treated with continuous renal replacement therapy (CRRT) (OR 0.97, 95% CI [0.46, 0.98], = 0.04). We also observed an increased mortality in patients in whom hemoadsorption was initiated earlier in the treatment course (OR 0.97, 95% CI [0.46, 0.98], = 0.04). We did not observe any significant difference in either intensive care unit length of stay ( = 0.93) or between end-of-treatment severity scores in the two groups ( = 0.24).
Although it has a high risk of bias, current evidence does not support the routine use of CytoSorb in critically ill septic patients. The addition of CytoSorb to CRRT may be associated with decreased survival as compared to CRRT alone, but future studies are needed to draw a definitive conclusion.
严重炎症导致器官功能障碍是脓毒症病理生理学的基石。因此，从理论角度来看，重新平衡炎症有可能改善患者预后。
为了更好地了解血液吸附在控制炎症方面的临床效果，我们对CytoSorb治疗重症脓毒症患者的效果进行了一项更新的荟萃分析。最终分析纳入了10项研究，共715例患者（干预组355例，对照组360例）。
统计分析表明，使用CytoSorb不影响总体死亡率（比值比0.95，95%置信区间[0.58, 1.56]，P = 0.85），但我们观察到，将接受CytoSorb治疗的患者与接受连续性肾脏替代治疗（CRRT）的对照组患者相比，死亡率有所降低（比值比0.97，95%置信区间[0.46, 0.98]，P = 0.04）。我们还观察到，在治疗过程中较早开始血液吸附的患者死亡率增加（比值比0.97，95%置信区间[0.46, 0.98]，P = 0.04）。我们未观察到两组在重症监护病房住院时间（P = 0.93）或治疗结束时的严重程度评分方面有任何显著差异（P = 0.24）。
尽管存在较高的偏倚风险，但目前的证据不支持在重症脓毒症患者中常规使用CytoSorb。与单独使用CRRT相比，在CRRT中添加CytoSorb可能与生存率降低有关，但需要未来的研究才能得出明确结论。
