Continuous renal replacement therapy with the adsorptive oXiris filter may be associated with the lower 28-day mortality in sepsis: a systematic review and meta-analysis

被引:41
作者
Wang, Guizhong [1 ]
He, Yuxuan [1 ]
Guo, Qingling [1 ]
Zhao, Ying [1 ]
He, Jie [1 ]
Chen, Yue [1 ]
Chen, Weijia [1 ]
Zhou, Yi [1 ]
Peng, Zichong [1 ]
Deng, Ke [1 ]
Guan, Jianbin [1 ]
Xie, Wenting [1 ]
Chang, Ping [1 ]
Liu, Zhanguo [1 ]
机构
[1] Southern Med Univ, Zhujiang Hosp, Sch Clin Med 2, Dept Crit Care Med, 253 Gongye Rd, Guangzhou 510282, Peoples R China
基金
中国国家自然科学基金;
关键词
oXiris; Sepsis; Mortality; Systematic review; Meta-analysis; ENDOTOXIN;
D O I
10.1186/s13054-023-04555-x
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BackgroundThe oXiris is a novel filter for continuous renal replacement therapy (CRRT) featuring an adsorption coating to adsorb endotoxins and remove inflammatory mediators. Given that no consensus has been reached on its potential benefits in treating sepsis, a meta-analysis was conducted to assess its impact on the clinical outcomes of this patient population.MethodsEleven databases were retrieved to find relevant observational studies and randomized controlled trials. The Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool were used to assess the quality of the included studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process was employed to assess the certainty of evidence. The 28-day mortality was the primary outcome. Secondary outcomes were 7-, 14-, and 90-day mortality, length of intensive care unit (ICU) and hospital stay, ICU and hospital mortality, norepinephrine (NE) dose, interleukin-6 (IL-6) and lactate levels, and Sequential Organ Failure Assessment (SOFA) score.ResultsThe meta-analysis, pooling data from 14 studies, involving 695 patients, showed significant reductions in 28-day mortality [odds ratio (OR) 0.53; 95% confidence interval (CI) 0.36-0.77, p = 0.001] and length of ICU stay [weighted mean difference (WMD) - 1.91; 95% CI - 2.56 to - 1.26, p < 0.001)] in patients with sepsis using the oXiris filter compared to other filters. Besides, the SOFA score, NE dose, IL-6 and lactate levels, and 7- and 14-day mortalities were lower in the oXiris group. However, the 90-day mortality, ICU and hospital mortality, and length of hospital stay were comparable. The quality assessment of the ten observational studies indicated intermediate to high quality (average Newcastle-Ottawa score: 7.8). However, all four randomized controlled trials (RCTs) had an unclear risk of bias. The evidence for all outcomes had a low or very low level of certainty because the original study design was mainly observational studies and the RCTs included had an unclear risk of bias and a small sample size.ConclusionThe treatment with the oXiris filter during CRRT in sepsis patients may be associated with lower 28-, 7-, and 14-day mortalities, lactate levels, SOFA score, NE dose, and shorter length of ICU stay. However, due to the low or very low quality of evidence, the effectiveness of oXiris filters was still uncertain. Besides, no significant difference was observed for the 90-day mortality, ICU and hospital mortality, and length of hospital stay.
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页数:13
相关论文
共 36 条
[1]  
Adamik BA, 2013, Crit Care, V17, pP66, DOI [10.1186/cc12004, DOI 10.1186/CC12004]
[2]   Endotoxin and cytokine reducing properties of the oXiris membrane in patients with septic shock: A randomized crossover double-blind study [J].
Broman, Marcus E. ;
Hansson, Fredrik ;
Vincent, Jean-Louis ;
Bodelsson, Mikael .
PLOS ONE, 2019, 14 (08)
[3]   Estimating the sample mean and standard deviation from order statistics and sample size in meta-analysis [J].
Cai, Siyu ;
Zhou, Jie ;
Pan, Jianxin .
STATISTICAL METHODS IN MEDICAL RESEARCH, 2021, 30 (12) :2701-2719
[4]  
Cochrane Library, COCHRANE HDB SYSTEMA
[5]  
Cochrane Library, POSS APPR SUMM ASS R
[6]   Intercoder Reliability and Validity of WebPlotDigitizer in Extracting Graphed Data [J].
Drevon, Daniel ;
Fursa, Sophie R. ;
Malcolm, Allura L. .
BEHAVIOR MODIFICATION, 2017, 41 (02) :323-339
[7]   Effect of CRRT with oXiris filter on hemodynamic instability in surgical septic shock with AKI: A pilot randomized controlled trial [J].
Feng, Junqi ;
Zhang, Shuyi ;
Ai, Tianyi ;
Wang, Lihui ;
Gao, Yuan ;
Li, Wen ;
Zhu, Mingli .
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS, 2022, 45 (10) :801-808
[8]  
gdt.gradepro.org/, GRADEPRO GDT
[9]   Blood Purification Techniques for Sepsis and Septic AKI [J].
Girardot, Thibaut ;
Schneider, Antoine ;
Rimmele, Thomas .
SEMINARS IN NEPHROLOGY, 2019, 39 (05) :505-514
[10]   Continuous Renal Replacement Therapy With Adsorbing Filter oXiris in Acute Kidney Injury With Septic Shock: A Retrospective Observational Study [J].
Guan, Mingjing ;
Wang, Hao ;
Tang, Xin ;
Zhao, Yuliang ;
Wang, Fang ;
Zhang, Ling ;
Fu, Ping .
FRONTIERS IN MEDICINE, 2022, 9