Effect of extracorporeal hemopurification for clinical prognosis and cytokine levels of septic: A meta-analysis

doi:10.3969/j.issn.1004-583X.2022.01.001

Abstract

Abstract:

Objective The purpose of this study is to systematically analyze the effect of extracorporeal hemopurification (EH) for clinical prognosis, and the association between EH-related cytokines levels and clinical prognosis for septic patients. Methods Available studies accessing the effect of extracorporeal hemopurification for septic patients were collected from Pubmed, Web of Science, Cochrane Library and China National Knowledge Internet between January 2010 and January 2020. Relationships between EH and in-hospital mortality (IHM) and length of intensive care unit in sepsis patients were calculated and systematically analyzed by Forest Plot in Review Manager 5.3. We further analyzed the correlation between changing of cytokine levels and clinical prognosis. Results Twenty-eight researches which covered a total of 2587 patients were included in this meta-analysis. The results indicated that EH (hemoperfusion, hemofiltration, hemoadsorption, cytosorb, et. al) could significantly decrease IHM (OR=0.83, P=0.04) without affecting the length of intensive care unit (OR=-0.50, P=0.69). Subgroup analysis suggested that High-volume Hemofltration or Hemoperfusion with Polymyxin B-immobilized cartridge failed to improve IHM (P=0.22; P=0.87); meanwhile, EH showed little therapy efficiency in severe burn septic patients or septic patients with acute kidney injury (P=0.08; P=0.77). During the whole EH period, septic patients with lower cytokine levels at last presented no benefit for a lower risk of IHM (P=0.48), but the length of intensive care unit was significantly decreased (OR=-17.58, P=0.04). Conclusion Routine EH is recommended for septic patients with no contraindication. Controlling relative levels of cytokines during the whole treatment is a useful way to shorten the length of intensive care unit.

Key words: sepsis, extracorporeal hemopurification, cytokine level, length of intensive care unit

CLC Number:

R631

Xiao Liuniu, Zhong Yanxia, Li Shusheng. Effect of extracorporeal hemopurification for clinical prognosis and cytokine levels of septic: A meta-analysis[J]. Clinical Focus, 2022, 37(1): 5-13.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.01.001

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I1/5

Figures/Tables 12

References 35

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纳入研究	患者数量	平均年龄(岁)	性别		体外血液净化技术	治疗方法(例)		死亡(例)		炎症因子下降(例)		ICU住院时间(d)
纳入研究	患者数量	平均年龄(岁)	男	女	体外血液净化技术	血液净化	传统治疗	血液净化	传统治疗	血液净化	传统治疗	血液净化	传统治疗
Hassan^[8] 2013	23	61.64	16	7	偶联血浆滤过吸附	11	12	5	10	-	-	10.27	8.75
Maynar^[9]2013	21	74.35	9	12	多黏菌素B血液灌注	14	7	3	3	-	-	5	6
Quenot^[10] 2015	60	66.6	42	18	高容量血液滤过	29	31	6	10	-	-	21	20
Quinto^[11] 2015	64	63.2	43	21	血液滤过	64	10	54	3	33	-	-
Schädler^[12] 2017	97	65.5	70	27	血液吸附	47	50	6	5	-	-	-	-
Guo^[13] 2017	22	54.3	15	7	高容量血液滤过	11	11	4	6	-	-	-	-
Huang^[14] 2010	44	74.8	24	20	血液灌注	24	20	11	11	-	-	27.9	29.4
Kim^[15] 2019	40	67.25	24	16	多黏菌素B血液灌注	20	20	10	10	-	-	10.9	14.6
Friesecke^[16] 2019	20	60.3	16	4	细胞因子吸附	20	18	2	8	1	31.2	67.2
Servillo^[17] 2013	13	58.07	7	6	血液滤过	13	3	10	2	5	3	4
Joannes-Boyau^[18]2013	137	69	83	54	高容量血液滤过	66	71	25	29	-	-	29	30
Chung^[19] 2017	37	48.5	26	11	高容量血液滤过	23	14	5	5	-	-	67	57
Park^[20] 2016	212	62.1	138	74	高容量血液滤过	105	107	69	69	-	-	18.2	11.5
Friesecke^[21] 2017	198	60.12	-	-	细胞因子吸附	135	63	88	48	-	-	16.77	34.9
Hawchar^[22] 2019	20	65.6	13	7	细胞因子吸附	10	10	1	3	-	-	10.2	10.0
Xu^[23] 2014	22	31.25	19	3	血液透析	11	11	1	4	6	8	-	-
Livigni^[24] 2014	184	65.25	121	63	偶联血浆滤过吸附	91	93	41	44	-	-	6.2	6.5
Tamme^[25] 2015	19	65	12	7	高容量血液滤过	19	9	10	8	8	11.5	34.5
Wu^[26] 2019	43	46.5	31	12	血液滤过	43	6	27	4	10	12.0	20.5
Kade^[27] 2016	28	60.29	-	-	高容量血液滤过	28	18	10	5	7	-	-
Zhang^[28] 2012	280	58.29	172	108	高容量血液滤过	141	139	81	81	-	21.9	25.9
Dellinger^[29] 2018	450	59.85	273	177	多黏菌素B血液灌注	224	226	78	85	-	-	-	-
Payen^[30] 2015	232	71.75	134	98	多黏菌素B血液灌注	119	113	33	22	-	-	-	-
You^[31] 2018	82	40.95	65	17	高容量血液滤过	41	41	9	13	-	-	34.5	28.5
Miao^[32] 2018	155	56	110	45	高容量血液滤过	93	62	26	21	-	-	11.7	15.4
Zuccrai^[33] 2020	9	-	5	4	细胞因子吸附	9	5	4	1	1	-	-
Shum^[34]2014	15	74.25	-	-	血液吸附	7	8	1	3	-	-	12.5	5.3
Peng^[35] 2012	60	-	-	-	血液灌注	30	30	14	23	20	10	8	4

纳入研究	患者数量	平均年龄(岁)	性别		体外血液净化技术	治疗方法(例)		死亡(例)		炎症因子下降(例)		ICU住院时间(d)
纳入研究	患者数量	平均年龄(岁)	男	女	体外血液净化技术	血液净化	传统治疗	血液净化	传统治疗	血液净化	传统治疗	血液净化	传统治疗
Hassan^[8] 2013	23	61.64	16	7	偶联血浆滤过吸附	11	12	5	10	-	-	10.27	8.75
Maynar^[9]2013	21	74.35	9	12	多黏菌素B血液灌注	14	7	3	3	-	-	5	6
Quenot^[10] 2015	60	66.6	42	18	高容量血液滤过	29	31	6	10	-	-	21	20
Quinto^[11] 2015	64	63.2	43	21	血液滤过	64	10	54	3	33	-	-
Schädler^[12] 2017	97	65.5	70	27	血液吸附	47	50	6	5	-	-	-	-
Guo^[13] 2017	22	54.3	15	7	高容量血液滤过	11	11	4	6	-	-	-	-
Huang^[14] 2010	44	74.8	24	20	血液灌注	24	20	11	11	-	-	27.9	29.4
Kim^[15] 2019	40	67.25	24	16	多黏菌素B血液灌注	20	20	10	10	-	-	10.9	14.6
Friesecke^[16] 2019	20	60.3	16	4	细胞因子吸附	20	18	2	8	1	31.2	67.2
Servillo^[17] 2013	13	58.07	7	6	血液滤过	13	3	10	2	5	3	4
Joannes-Boyau^[18]2013	137	69	83	54	高容量血液滤过	66	71	25	29	-	-	29	30
Chung^[19] 2017	37	48.5	26	11	高容量血液滤过	23	14	5	5	-	-	67	57
Park^[20] 2016	212	62.1	138	74	高容量血液滤过	105	107	69	69	-	-	18.2	11.5
Friesecke^[21] 2017	198	60.12	-	-	细胞因子吸附	135	63	88	48	-	-	16.77	34.9
Hawchar^[22] 2019	20	65.6	13	7	细胞因子吸附	10	10	1	3	-	-	10.2	10.0
Xu^[23] 2014	22	31.25	19	3	血液透析	11	11	1	4	6	8	-	-
Livigni^[24] 2014	184	65.25	121	63	偶联血浆滤过吸附	91	93	41	44	-	-	6.2	6.5
Tamme^[25] 2015	19	65	12	7	高容量血液滤过	19	9	10	8	8	11.5	34.5
Wu^[26] 2019	43	46.5	31	12	血液滤过	43	6	27	4	10	12.0	20.5
Kade^[27] 2016	28	60.29	-	-	高容量血液滤过	28	18	10	5	7	-	-
Zhang^[28] 2012	280	58.29	172	108	高容量血液滤过	141	139	81	81	-	21.9	25.9
Dellinger^[29] 2018	450	59.85	273	177	多黏菌素B血液灌注	224	226	78	85	-	-	-	-
Payen^[30] 2015	232	71.75	134	98	多黏菌素B血液灌注	119	113	33	22	-	-	-	-
You^[31] 2018	82	40.95	65	17	高容量血液滤过	41	41	9	13	-	-	34.5	28.5
Miao^[32] 2018	155	56	110	45	高容量血液滤过	93	62	26	21	-	-	11.7	15.4
Zuccrai^[33] 2020	9	-	5	4	细胞因子吸附	9	5	4	1	1	-	-
Shum^[34]2014	15	74.25	-	-	血液吸附	7	8	1	3	-	-	12.5	5.3
Peng^[35] 2012	60	-	-	-	血液灌注	30	30	14	23	20	10	8	4