Effect of Cytokine Adsorption on Mortality: A Meta-Analysis

ABSTRACT

Background: Cytokine adsorption using the CytoSorb device had been proposed to be beneficial in various clinical settings including sepsis, ARDS, hyperinflammatory syndromes, cardiac surgery or recovery after cardiac arrest. The aim of this analysis was to provide evidence for the efficacy of the CytoSorb device with regard to mortality in these settings. Method(s) We searched Medline, Cochrane Library database and used the database provided by CytosorbentsTM. Central Register of Controlled Trials and clinicaltrials. gov for randomized, controlled studies (01.1.2010-28.2.22). We considered randomized controlled trials and observational studies with a control group. The longest reported mortality (30 days-, hospital- or ICU-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 (R 4.1). We analysed all studies together and separated in the subgroups sepsis, cardiac surgery, SARS-CoV-2 infection, recovery from cardiac arrest, other severe illness. The meta-analysis was registered in advance (PROSPERO CRD42022290334). Result(s) Of initial 1249 publications, 37 trials were found eligible, in total including 1256 patients treated with CytoSorb and 1230 controls. Concerning the primary endpoint mortality Cytosorb did not show a positive effect in all studies together 1.10 [0.92;1.33] RR [95%-CI], in sepsis 1.03 [0.81;1.31], CPB surgery 0.85 [0.51;1.44], severe illness 1.05 [0.79;1.39], SARS-CoV-2 1.58 [0.50;4.94], and recovery from cardiac arrest 1.22 [1.02;1.46] (figure). Likewise we did not find significant difference in ICU length of stay, lactate levels, or norepinephrine after treatment. Conclusion(s) To date there is no evidence for a positive effect of the CytoSorb adsorber on mortality across a bunch of indications that justifies its widespread use in intensive care medicine. (Table Presented).