Plasma Levels of Myocardial MicroRNA-133a Increase by Intraoperative Cytokine Hemoadsorption in the Complex Cardiovascular Operation

Wágner, Robert; Souček, Přemysl; Ondrášek, Jiří; Fila, Petr; Štěrba, Ján; Spacilova, Hana; Michalcikova, Alzbeta; Freiberger, Tomáš; Němec, Petr

doi:10.14740/jocmr3989

Cited by 15 publications

(24 citation statements)

References 32 publications

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“…The systematic search in online databases produced 1362 potential titles and abstracts from database and hand searches (Figure 1). Thirty reports were identified for review, and after exclusion of ongoing trials and inadequate reports (Table S2), we included 19 reports from 18 unique trials with a total of 866 patients 19–21,29–35,36–43 …”

Section: Resultsmentioning

confidence: 99%

“…Thirty reports were identified for review, and after exclusion of ongoing trials and inadequate reports (Table S2), we included 19 reports from 18 unique trials with a total of 866 patients. [19][20][21][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]…”

Section: Systematic Searchmentioning

confidence: 99%

“…All but a single published trial 37 reported details on author financial conflict of interest and funding sources (Table S4). Twelve trials were judged to have notable concern about conflict of interest, 2 trials had no concerns, 33,34 and 4 had unclear status. 37,[41][42][43] Eight trials were financially supported by the CytoSorb ® manufacturer.…”

Section: Conflict Of Interestmentioning

confidence: 99%

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Mortality and adverse events of hemoadsorption with CytoSorb® in critically ill patients: A systematic review and meta‐analysis of randomized controlled trials

Heymann

Schorer

Putzu

2022

Acta Anaesthesiol Scand

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Background: The effects and safety of extracorporeal hemoadsorption with CytoSorb ® in critically ill patients with inflammatory conditions are controversial.Methods: We performed a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized-controlled trials to assess the mortality and safety of CytoSorb ® therapy in critically ill patients with inflammatory conditions. Electronic databases were searched up to April 2022. The primary outcome was mortality at longest follow-up and secondary outcomes included various adverse event (AE) outcomes. Conflict of interest and funding of each trial were assessed. We calculated relative risk (RR) and 95% confidence interval (CI).Results: Fourteen published (n = 764) and 4 unpublished (n = 111) trials were included. Eight trials were performed in medical ICU patients and 10 in complex cardiac surgery. Ten trials had significant industrial funding or an author conflict of interest. Hemoadsorption with CytoSorb ® was associated with higher mortality at latest follow-up (16 trials, n = 807, 120 of 402 [29.85%] patients in the CytoSorb ® group vs. 98 of 405 [24.20%] patients in the control group, RR = 1.24 [95% CI, 1.04-1.49], p = .02, [TSA-adjusted CI, 0.92-1.68]) and at 30-days or in-hospital (11 trials, n = 727; RR = 1.41 [95% CI, 1.06-1.88], p = .02, ). Only one trial reported the definition of adverse event, while detailed results were reported in 3 trials; the risk of adverse events was not higher with CytoSorb ® . Certainty of evidence ranged from low to very low. Conclusion:Low certainty of evidence showed that the use of CytoSorb ® might increase mortality in critically ill patients with inflammatory conditions. Adverse events were frequent but underreported and not systematically evaluated. Industrial funding and conflict of interest were common. Considerable uncertainty about the findings does not allow firm conclusions and suggests a need for high-quality randomized trials to clarify mortality and adverse events related to CytoSorb ® .Editorial Comment: Hemoadsorption with CytoSorb ® have been used in critically ill patients despite lack of high quality data from RCTs suggesting any patient-important benefits. The findings from this systematic review and meta-analysis suggests an

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Section: Resultsmentioning

confidence: 99%

Section: Systematic Searchmentioning

confidence: 99%

Section: Conflict Of Interestmentioning

confidence: 99%

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Mortality and adverse events of hemoadsorption with CytoSorb® in critically ill patients: A systematic review and meta‐analysis of randomized controlled trials

Heymann

Schorer

Putzu

2022

Acta Anaesthesiol Scand

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“…From a new perspective on the application of hemadsorption in the comprehensive operation of aortic root: Ross operation (3%) and David operation (7%), Wagner et al [ 85 ] focused on the cross regulation between cytokines and miRNA. By measuring the plasma levels of miRNA in the myocardium, monocyte, and vasculature, it can be inferred whether intraoperative hemadsorption modulates the inflammatory process.…”

Section: Evidence For the Application Of Cytosorb During Cpb Surgerymentioning

confidence: 99%

Application of Adsorptive Blood Purification Techniques during Cardiopulmonary Bypass in Cardiac Surgery

Liu

Zhou

2022

Oxidative Medicine and Cellular Longevity

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By reason of surgical demand, the majority of cardiovascular procedures still depend on the use of cardiopulmonary bypass (CPB). Due to the nonphysiological state of CPB, it can cause complex and unpredictable inflammatory response, which may lead to significant morbidity and mortality. Unfortunately, the pharmacological and mechanical strategies that currently exist do not offer significant advantages in controlling inflammatory response and improving patient outcomes. The best strategy to reduce inflammation in CPB is still uncertain. In recent years, adsorptive blood purification techniques (BPTs) have emerged, among which CytoSorb is the latest representative device. Currently, the primary application area of adsorptive BPTs is in the control and treatment of systemic hyperinflammatory states, such as refractory septic shock patients. However, the evidences on efficacy and safety of adsorptive BPTs application during CPB surgery are still inconclusive, so we summarize the relevant evidences here and suggest future potential research areas.

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“…Eight studies included less than 15 participants per group. 23,25,36,42,43,48,53,55 These studies achieved great effects with CytoSorb® intervention. By contrast, there are larger RCTs and PSMs with notably smaller effect sizes.…”

Section: Risk Of Biasmentioning

confidence: 99%

Efficacy of CytoSorb® - A Metaanalysis

Becker

Lang

Barbosa

et al. 2022

Preprint

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Cytokine adsorption using the CytoSorb® device has been proposed in various clinical settings including sepsis, ARDS, hyperinflammatory syndromes, cardiac surgery or recovery after cardiac arrest. The aim of this analysis is to provide evidence for the efficacy of the CytoSorb® device with regard to mortality in various settings. Methods: We searched PubMed, Cochrane Library database and the database provided by Cytosorbents™ (01.1.2010–29.5.2022). We considered randomized controlled trials and intervention studies with control groups. The longest reported mortality was defined as primary endpoint. For analyzing the data, we computed risk ratios and 95%-confidence intervals and used DerSimonian and Lairds random effects model. We analyzed all studies combined and divided into the subgroups sepsis, cardiac surgery, other severe illness, SARS-CoV-2 infection and recovery from cardiac arrest. The meta-analysis was registered in advance (PROSPERO: CRD42022290334). Results: Of an initial 1295 publications, 34 studies were found eligible, including 1297 patients treated with CytoSorb® and 1314 controls. Cytosorb® did not lower mortality in all studies together (1.07 [0.88; 1.31] RR [95%-CI]), in sepsis (0.98 [0.74; 1.31]), CPB surgery (0.91 [0.64; 1.29]), severe illness (0.95 [0.59; 1.55]) or SARS-CoV-2 (1.58 [0.50; 4.94]). In patients with cardiac arrest, we found a significant survival advantage of the untreated controls (RR 1.22 [1.02; 1.46]). We did not find significant differences in ICU length of stay, lactate levels, or IL-6 levels after treatment. Interpretation: To date there is no evidence for a positive effect of the CytoSorb® adsorber on mortality across a variety of indications that justifies its widespread use in intensive care medicine.

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Plasma Levels of Myocardial MicroRNA-133a Increase by Intraoperative Cytokine Hemoadsorption in the Complex Cardiovascular Operation

Cited by 15 publications

References 32 publications

Mortality and adverse events of hemoadsorption with CytoSorb® in critically ill patients: A systematic review and meta‐analysis of randomized controlled trials

Mortality and adverse events of hemoadsorption with CytoSorb® in critically ill patients: A systematic review and meta‐analysis of randomized controlled trials

Application of Adsorptive Blood Purification Techniques during Cardiopulmonary Bypass in Cardiac Surgery

Efficacy of CytoSorb® - A Metaanalysis

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