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

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

PAMPs and DAMPs in Sepsis: A Review of Their Molecular Features and Potential Clinical Implications

“…In a case series of post-neurosurgery septic shock patients, the combination of CRRT and CytoSorb caused permanent or transient clinical improvement, but even if the authors hypothesize a role for DAMPs and PAMPs removal, none of them has been measured [174]. Even if CytoSorb has been approved for the treatment of critical patients since 2011, some meta-analyses have found no significant impact on mortality, so the authors conclude that there is not striking evidence to recommend its systematic use outside clinical trials [175][176][177].…”

Science over language: a plea to consider language bias in scientific publishing

“…For instance, Critical Care Science , the official journal of the Associação de Medicina Intensiva Brasileira (AMIB) and the Sociedade Portuguesa de Cuidados Intensivos (SPCI), requires manuscripts to be submitted either in English or Portuguese (it publishes accepted articles in both languages) but receives a significant number of submissions from countries where neither of these are a native language. ( 2 , 3 )…”

“…Por exemplo, a Critical Care Science , a revista oficial da Associação de Medicina Intensiva Brasileira (AMIB) e da Sociedade Portuguesa de Cuidados Intensivos (SPCI), exige que os manuscritos sejam enviados em inglês ou português (ela publica os artigos aceitos em ambos os idiomas), mas recebe um número significativo de envios de países em que nenhum desses idiomas é nativo. ( 2 , 3 )…”