Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements

Table 2 Multiple logistic regression analysis to predict 30 d mortality

Ref.	Study design	Population	Intervention	Outcomes
Friesecke et al[62], 2017	Prospective, single center study	20 septic shock patients	CytoSorb hemoperfusion	Norepinephrinedose reduced after 6 and 12 h; Improved lactate clearance; SOFA scores unchanged; Shock reversal achieved in 65% of patients; 28-d survival – 45%
Kogelmann et al[63], 2017	Case series	26 septic shock patients	CytoSorb+CVVHD	Rapid hemodynamic stabilization; Reduction in Vasopressor dose by 67%; Decrease in blood lactate by 26.4%; Shock reversal in 38.5% patients; Decreased mortality than predicted by APACHE II; No adverse events reported
Friesecke et al[52], 2017	International registry	135 septic shock patients	CytoSorb hemoperfusion	Reduced observed mortality of 65% than predicted by APACHE II of 78%; Marked reduction in IL6 levels; No significant reduction in SOFA scores; Safe and well tolerated without any adverse events
Brouwer et al[59], 2019	Retrospective, investigator-initiated study	116 septic shock patients	CytoSorb +CRRT	In CytoSorb group, the mean predicted mortality rate was 74.5%, while 28 d mortality rate was 47.8%; In CRRT group, the mean predicted mortality rate was 67.9%, while 28-d mortality was 51.0%; CytoSorb group was associated with a reduced 28-d mortality in comparison to CRRT (53% vs 72.3%)
			CRRT alone
Brouwer et al[60], 2021	Long term follows up	116 septic shock patients	CytoSorb +CRRT	CytoSorb was significantly associated with long term outcome compared to CRRT
	Retrospective cohort study		CRRT alone
Mehta et al[53], 2020	Retrospective, observational study	40 septic shock patients	CytoSorb hemoperfusion (Survivor group vs non survivor group)	Improvement in MAP (62.82 ± 9.73mmHg); Reduction in vasopressor dose; Reduction IL-6 levels (87%) and TNF levels (24%); Decrease in SOFA scores by 16.2%
Paul et al[68], 2021	Prospective, real time, observational multicentre study	45 septic shock patients	CytoSorb+ Standard therapy	26 patients survived post therapy; Reduction in vasopressor dose (NE- 51.4%, Epinephrine – 69.4% and Vasopressin -13.9%); 52.3% reduction in IL-6 levels; Reduction in APACHE II and SOFA scores, 20.1 ± 2.47 and 9.04 ± 3.00 respectively
			(Survivor vs non survivor group)
Akil et al[69], 2020		20 patients with pneumogenic sepsis and ARDS	CytoSorb + Combined high flow veno-venous ECMO (CytoSorb group); ECMO therapy alone (Control group)	The 30-d mortality rate was 0% in CytoSorb group, whereas 57% was observed in control group; Significant reduction in procalcitonin and C-reactive levels were observed in CytoSorb group in comparison to control group
Rugg et al[61], 2020	Retrospective single center study	42 septic shock patients compared to 42 matched controls	Cytosorb +RRT	Catecholamines requirements decreased to 0.26 µg/kg/min within 24 h of therapy with CytoSorb; In hospital mortality was significantly lower in CytoSorb group as compared to controls (35.7% vs 61.9%); Risk factors in CytoSorb group were high lactate levels and low thrombocyte counts proior to therapy. Lactate value of 7.5 mmol/L, predicted mortality with high specificicty (88.9%)

CVVHD: Continuous veno-venous hemodilation; NE: Norepinephrine; MAP: Mean arterial pressure; SOFA: Sequential organ failure assessment; APACHE: Acute physiology and chronic health evaluation; IL: Interleukin; TNF: Tumor necrosis factor; ARDS: Acute respiratory distress syndrome; CRRT: Continuous renal replacement therapy; RRT: Renal replacement therapy.