The following is a summary of “Effect of CytoSorb on Inflammatory Markers in Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” published in the August 2023 issue of Critical Care by Heymann et al.
Researchers started a retrospective study to assess the effectiveness of CytoSorb in removing inflammatory mediators in critically ill patients.
They conducted a search of electronic databases from inception (May 2023). Studies of CytoSorb in critically ill patients with high inflammation were included. Two authors screened articles for eligibility, extracted data, and assessed the risk of bias, conflicts of interest, and certainty of evidence (CoE). The primary outcome was interleukin (IL)-6 at 1 day after the initiation of the therapy. Secondary outcomes encompassed various inflammatory markers at 1, 2, 3, and 5 days and mortality. Data from at least 3 trials were combined and analyzed using a random-effects model.
The results showed 17 trials (with a total of 855 participants). Out of these, 14 trials raised notable concerns about conflicts of interest. Seven trials were conducted in medical ICU patients with hyperinflammatory conditions, and 10 were performed in complex cardiovascular surgery cases under cardiopulmonary bypass. Hemoadsorption with CytoSorb did not result in lower IL-6 levels at 1 day (mean difference -5.98 [95% CI, -30.44 to 18.48] pg/mL), 2 days, 3 days, or 5 days after initiating the treatment, nor did it affect the concentration of procalcitonin. C-reactive protein levels were also not reduced with CytoSorb at 1, 2, and 3 days. CytoSorb was linked to higher mortality rates at the latest follow-up (relative risk = 1.22 [95% CI, 1.02–1.45]) and at 30 days. The certainty of evidence ranged from low to very low.
They concluded that CytoSorb hemoadsorption does not consistently reduce inflammation in critically ill patients, requiring further research.