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Randomised clinical trials did not provide conclusive evidence for benefits and even suggest risks in COVID-19 patients. Retrospective observational cohort study based on hospital remuneration data from all COVID-19 patients treated in intensive care units in Germany between 01\/01\/2020 and 12\/31\/2021. Regression modelling was performed for 1:1 propensity score matching of 2058 patients. Two-sided probability values for group comparisons and regression models with spline functions controlling for non-linear relationships and medically relevant interaction variables were calculated. In-hospital mortality of patients supported with haemoadsorption was significantly higher compared to matched control patients (74.6% vs. 70.3%, <jats:italic>p<\/jats:italic>\u2009=\u20090.0299). Haemoadsorption was associated with coagulopathy (68.0% vs. 54.9%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), cardiac arrhythmia (49.2% vs. 44.2%, <jats:italic>p<\/jats:italic>\u2009=\u20090.0272), and cardiopulmonary resuscitation (CPR, 19.3% vs. 13.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.0002). Further, haemoadsorption increased the chance of death for COVID-19 patients without septic shock (odds ratio, OR [within a 95% confidence interval, CI]; 1.40 [1.05\u20131.86]) and did not improve survival of septic shock patients (1.19 [0.85\u20131.67]). Independent variables with a significant impact on mortality included the use of extracorporeal membrane oxygenation (ECMO, 2.15 [1.68\u20132.76]) and CPR (1.60 [1.03\u20132.45]). The timing of the haemoadsorption therapy had no effect on patients\u00b4 outcomes. Due to inconclusive evidence for benefit and potential harm, haemoadsorption therapy should be limited to thoroughly designed clinical trials before introduced into clinical routine in the context of COVID-19.<\/jats:p>","DOI":"10.1038\/s41598-025-13860-0","type":"journal-article","created":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T10:39:02Z","timestamp":1754735942000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Critical risks of haemoadsorption for COVID-19 patients and directions for future evaluations: a nationwide propensity score matched cohort study"],"prefix":"10.1038","volume":"15","author":[{"given":"Jan Andreas","family":"Kloka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Jasny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Old","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elina","family":"N\u00fcrenberg-Goloub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Scharf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Meybohm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Supady","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Zacharowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Friedrichson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,9]]},"reference":[{"key":"13860_CR1","doi-asserted-by":"publisher","first-page":"7199","DOI":"10.3390\/jcm12237199","volume":"12","author":"S Mitzner","year":"2023","unstructured":"Mitzner, S. et al. 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Braun Melsungen, CSL Behring, Fresenius Kabi, and Vifor Pharma for the implementation of Frankfurt\u2018s Patient Blood Management program.KZ has received honoraria for participation in advisory board meetings for Haemonetics and Vifor and received speaker fees from CSL Behring, Masimo, Pharmacosmos, Boston Scientific, Salus, iSEP, Edwards, Hemosonics and GE Healthcare. He is the Principal Investigator of the EU-Horizon 2020 project ENVISION (Intelligent plug-and-play digital tool for real-time surveillance of COVID-19 patients and smart decision-making in Intensive Care Units) and Horizon Europe 2021 project COVend (Biomarker and AI-supported FX06 therapy to prevent progression from mild and moderate to severe stages of COVID-19). Partner for EU Horizon 2023 project EDiHTA. J.K. and B.F. are Deputy Principal Investigator of ENVISION and COVend. A.S. and P.M. reports travel support, lecture honoraria (C.S.) and research funding from CytoSorbents Europe and lecture honoraria from Getinge. All other authors have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"All data processing was performed in accordance with the Declaration of Helsinki. According to \u00a7\u00a021KHEntgG the reimbursement data is available for scientific use. Due to the institutional anonymization and retrospective nature of the study, no conclusions can be drawn at the individual case level. For this reason, the Ethics Committee of University Hospital Frankfurt waived the requirement for ethical approval and the need to obtain informed consent for this study (Chair: Prof. Dr. Harder, Ref: 2022\u2013766).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"As these are anonymised register data, no consensus of the patients can be collected.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"29184"}}