Dutta Palak, Ganduboina Rohit, Muderrisoglu Cankutay, Obulareddy Adithya C Reddy, Palagati Keerthi, Areddy Vivekananda Reddy, Reddy Gaddam Ashwith, Sainathan Sandeep
Department of Surgery, University of Illinois, Chicago, IL, USA.
Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, India.
Asian Cardiovasc Thorac Ann. 2025 Mar;33(2-3):105-115. doi: 10.1177/02184923251328119. Epub 2025 Mar 28.
IntroductionInfective endocarditis (IE) is a severe infection of the endocardium, primarily affecting the heart valves, exhibiting high morbidity and mortality rates. Cardiac surgery for IE with cardiopulmonary bypass (CPB) can further exacerbate the inflammatory response and cytokine production from IE. The current meta-analysis evaluates the use of CytoSorb hemoadsorption in IE patients undergoing cardiac surgery to determine its efficacy in reducing inflammatory mediators and improving clinical outcomes.MethodsPubMed, Cochrane, Google Scholar, Clinical Trials, and Google Scholar were searched for articles until July 2024. After performing a risk of bias and quality assessment, data on operative times, mortality, and morbidity were extracted for meta-analysis. Statistical Software R (version 4.4.0) was used to calculate odds ratio (OR) and standardized mean differences using a random-effect model with a 95% confidence interval (CI) and -value less than 0.05.ResultsEight studies, encompassing 1076 patients, were included in the analysis. These comprised three randomized controlled trials and five nonrandomized studies. The majority of these studies exhibited some concerns regarding bias. Hemoadsorption group showed lower discharge mortality (OR: 0.58, 95% CI: 0.33-1.00, = 0.05) compared to controls, but no significant disparity is observed in other outcomes. In-hospital outcomes also showed higher heterogeneity, with an ² value greater than 50%.ConclusionCytoSorb use in patients undergoing cardiac surgery with CPB used for IE has no impact on operative mortality and morbidity but has a beneficial effect on discharge mortality.
引言
感染性心内膜炎（IE）是一种严重的心内膜感染，主要影响心脏瓣膜，具有较高的发病率和死亡率。采用体外循环（CPB）进行的IE心脏手术会进一步加剧IE引发的炎症反应和细胞因子生成。本荟萃分析评估了CytoSorb血液吸附在接受心脏手术的IE患者中的应用，以确定其在减少炎症介质和改善临床结局方面的疗效。
方法
检索PubMed、Cochrane、谷歌学术、临床试验数据库以及谷歌学术，截至2024年7月的文章。在进行偏倚风险和质量评估后，提取手术时间、死亡率和发病率的数据进行荟萃分析。使用统计软件R（版本4.4.0），采用随机效应模型计算比值比（OR）和标准化均数差，95%置信区间（CI）且P值小于0.05。
结果
八项研究共纳入1076例患者，包括三项随机对照试验和五项非随机研究。这些研究大多存在一些偏倚问题。与对照组相比，血液吸附组出院时死亡率较低（OR：0.58，95%CI：0.33 - 1.00，P = 0.05），但在其他结局方面未观察到显著差异。住院结局也显示出较高的异质性，I²值大于50%。
结论
在用于IE的CPB心脏手术患者中使用CytoSorb对手术死亡率和发病率无影响，但对出院死亡率有有益作用。
