{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:14:10Z","timestamp":1791562450924,"version":"4.3.4"},"reference-count":41,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CytoSorbents Europe GmbH"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Septic shock remains a significant clinical challenge with consistently high mortality rates. Recent investigations have focused on the efficacy of CytoSorb\u00ae (CytoSorbents Corporation, Monmouth Junction, NJ, USA), an extracorporeal cytokine adsorber, and how it impacts outcomes in sepsis. The current meta-analysis reports on the impact of CytoSorb\u00ae on survival, specifically in septic shock patients. Methods: We conducted a comprehensive systematic search across the PubMed and COCHRANE databases for studies published up to 10 June 2024. The analysis prioritized randomized controlled trials and observational studies with control groups involving septic shock patients while excluding case reports and case series. Nine studies were finally included in our meta-analysis following the initial screening of 115 articles after excluding duplicates and irrelevant entries. Results: The meta-analysis was performed on 744 critically ill patients with septic shock from one RCT and eight observational studies. Of these, 449 patients received treatment with CytoSorb\u00ae in addition to standard care. Our data indicate that CytoSorb\u00ae use is associated with reduced in-hospital mortality, evidenced by an odds ratio (OR) of 0.64 [0.42; 0.97] and a p-value of 0.036. For 28\u201330-day mortality, the findings were more pronounced with an OR of 0.46 [0.28; 0.78] and a p-value of 0.003. The analysis of the longest observed mortality showed a trend for improved survival within the CytoSorb group; however, it did not reach statistical significance. Additionally, there was a significant improvement in hemodynamic stability as a secondary endpoint, as evidenced by notable reductions in vasopressor requirements in the hemoadsorption group. Conclusions: The current meta-analysis suggests that the use of CytoSorb\u00ae alongside standard of care management may be linked to improved short-term survival in patients with septic shock; however, these findings should be interpreted with caution in light of the heterogeneity and the modest quality of the studies included. Prospective studies are needed to better determine the impact of hemoadsorption on shock reversal and survival in these critically ill patients.<\/jats:p>","DOI":"10.3390\/jcm14072285","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T03:35:28Z","timestamp":1743132928000},"page":"2285","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Hemoadsorption in the Management of Septic Shock: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6983-0171","authenticated-orcid":false,"given":"David","family":"Steindl","sequence":"first","affiliation":[{"name":"Charit\u00e9 Poison Control Center, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, 1220 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5399-0576","authenticated-orcid":false,"given":"Tim","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Krannich","sequence":"additional","affiliation":[{"name":"BioStats GmbH, 14641 Nauen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9888-4358","authenticated-orcid":false,"given":"Jens","family":"Nee","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1186\/s13054-020-02950-2","article-title":"Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019\u2014Results from a systematic review and meta-analysis","volume":"24","author":"Bauer","year":"2020","journal-title":"Crit. Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"456","DOI":"10.3390\/epidemiologia5030032","article-title":"The Global Burden of Sepsis and Septic Shock","volume":"5","author":"Sangiorgio","year":"2024","journal-title":"Epidemiologia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2909","DOI":"10.12688\/f1000research.9092.1","article-title":"Agents to reduce cytokine storm","volume":"5","author":"Gerlach","year":"2016","journal-title":"F1000Research"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Zhang, H., He, F., Li, P., Hardwidge, P.R., Li, N., and Peng, Y. (2021). The Role of Innate Immunity in Pulmonary Infections. BioMed Res. Int., 2021.","DOI":"10.1155\/2021\/6646071"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1038\/nri3024","article-title":"Neutrophils in the activation and regulation of innate and adaptive immunity","volume":"11","author":"Mantovani","year":"2011","journal-title":"Nat. Rev. Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1186\/s13054-023-04762-6","article-title":"Targeting the host response in sepsis: Current approaches and future evidence","volume":"27","author":"Bode","year":"2023","journal-title":"Crit. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s13054-023-04310-2","article-title":"Rationale for sequential extracorporeal therapy (SET) in sepsis","volume":"27","author":"Ronco","year":"2023","journal-title":"Crit. Care"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Mitzner, S., Kogelmann, K., Ince, C., Moln\u00e1r, Z., Ferrer, R., and Nierhaus, A. (2023). Adjunctive Hemoadsorption Therapy with CytoSorb in Patients with Septic\/Vasoplegic Shock: A Best Practice Consensus Statement. J. Clin. Med., 12.","DOI":"10.3390\/jcm12237199"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1159\/000067860","article-title":"Sorbents in acute renal failure and the systemic inflammatory response syndrome","volume":"21","author":"Winchester","year":"2003","journal-title":"Blood Purif."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1159\/000080235","article-title":"Cytokine removal with a novel adsorbent polymer","volume":"22","author":"Song","year":"2004","journal-title":"Blood Purif."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1097\/01.CCM.0000114997.39857.69","article-title":"Hemoadsorption removes tumor necrosis factor, interleukin-6, and interleukin-10, reduces nuclear factor-kappaB DNA binding, and improves short-term survival in lethal endotoxemia","volume":"32","author":"Kellum","year":"2004","journal-title":"Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s13054-023-04391-z","article-title":"CytoSorb hemoperfusion markedly attenuates circulating cytokine concentrations during systemic inflammation in humans in vivo","volume":"27","author":"Jansen","year":"2023","journal-title":"Crit. Care"},{"key":"ref_13","unstructured":"(2020, June 03). Cochrane Handbook for Systematic Reviews and Interventions. Available online: http:\/\/training.cochrane.org\/handbook."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_17","unstructured":"JBI Global Wiki (2024, September 15). Systematic Reviews of Etiology and RISK\u2014JBI Manual for Evidence Synthesis. Available online: https:\/\/jbi-global-wiki.refined.site\/space\/MANUAL\/355598596\/7.+Systematic+reviews+of+etiology+and+risk."},{"key":"ref_18","first-page":"719","article-title":"Statistical aspects of the analysis of data from retrospective studies of disease","volume":"22","author":"Mantel","year":"1959","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1186\/s13054-019-2588-1","article-title":"Hemoadsorption with CytoSorb shows a decreased observed versus expected 28-day all-cause mortality in ICU patients with septic shock: A propensity-score-weighted retrospective study","volume":"23","author":"Brouwer","year":"2019","journal-title":"Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1159\/000512309","article-title":"Improved Survival beyond 28 Days up to 1 Year after CytoSorb Treatment for Refractory Septic Shock: A Propensity-Weighted Retrospective Survival Analysis","volume":"50","author":"Brouwer","year":"2020","journal-title":"Blood Purif."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.jcrc.2018.11.003","article-title":"Extracorporeal cytokine adsorption in septic shock: A proof of concept randomized, controlled pilot study","volume":"49","author":"Hawchar","year":"2019","journal-title":"J. Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Rugg, C., Klose, R., Hornung, R., Innerhofer, N., Bachler, M., Schmid, S., Fries, D., and Str\u00f6hle, M. (2020). Hemoadsorption with CytoSorb in Septic Shock Reduces Catecholamine Requirements and In-Hospital Mortality: A Single-Center Retrospective \u201cGenetic\u201d Matched Analysis. Biomedicines, 8.","DOI":"10.3390\/biomedicines8120539"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s13613-020-00772-7","article-title":"Adsorption therapy in critically ill with septic shock and acute kidney injury: A retrospective and prospective cohort study","volume":"10","author":"Schittek","year":"2020","journal-title":"Ann. Intensiv. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1055\/s-0040-1708479","article-title":"Combined Use of CytoSorb and ECMO in Patients with Severe Pneumogenic Sepsis","volume":"69","author":"Akil","year":"2021","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Kogelmann, K., H\u00fcbner, T., Schwameis, F., Dr\u00fcner, M., Scheller, M., and Jarczak, D. (2021). First Evaluation of a New Dynamic Scoring System Intended to Support Prescription of Adjuvant CytoSorb Hemoadsorption Therapy in Patients with Septic Shock. J. Clin. Med., 10.","DOI":"10.3390\/jcm10132939"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1007\/s00134-021-06512-0","article-title":"Cytokine adsorption in severe, refractory septic shock","volume":"47","author":"Garcia","year":"2021","journal-title":"Intensiv. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bottari, G., Guzzo, I., Cappoli, A., Labbadia, R., Perdichizzi, S., Serpe, C., Creteur, J., Cecchetti, C., and Taccone, F.S. (2023). Impact of CytoSorb and CKRT on hemodynamics in pediatric patients with septic shock: The PedCyto study. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1259384"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.burns.2024.02.028","article-title":"CytoSorb\u00ae in burn patients with septic shock and Acute Kidney Injury on Continuous Kidney Replacement Therapy is associated with improved clinical outcome and survival","volume":"50","author":"Mariano","year":"2024","journal-title":"Burns"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Sch\u00e4dler, D., Pausch, C., Heise, D., Meier-Hellmann, A., Brederlau, J., Weiler, N., Marx, G., Putensen, C., Spies, C., and J\u00f6rres, A. (2017). The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0187015"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1186\/s13054-023-04492-9","article-title":"Efficacy of CytoSorb\u00ae: A systematic review and meta-analysis","volume":"27","author":"Becker","year":"2023","journal-title":"Crit. Care"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kasper, R., Rodriguez-Alfonso, A., St\u00e4ndker, L., Wiese, S., and Schneider, E.M. (2024). Major endothelial damage markers identified from hemadsorption filters derived from treated patients with septic shock\u2014Endoplasmic reticulum stress and bikunin may play a role. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1359097"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Piskovatska, V., Santos, A.N., Kalies, K., Korca, E., Stiller, M., Szab\u00f3, G., Simm, A., and W\u00e4chter, K. (2023). Proteins Adsorbed during Intraoperative Hemoadsorption and Their In Vitro Effects on Endothelium. Healthcare, 11.","DOI":"10.3390\/healthcare11030310"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bottari, G., Confalone, V., Creteur, J., Cecchetti, C., and Taccone, F.S. (2024). The Sublingual Microcirculation in Critically Ill Children with Septic Shock Undergoing Hemoadsorption: A Pilot Study. Biomedicines, 12.","DOI":"10.21203\/rs.3.rs-4201848\/v1"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1186\/s13054-023-04736-8","article-title":"Cytokine removal: Do not ban it, but learn in whom and when to use it","volume":"27","author":"Schmidt","year":"2023","journal-title":"Crit. Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1186\/s13054-023-04638-9","article-title":"Blood purification in critically ill patients: Not enough, but still helpful","volume":"27","author":"Pappalardo","year":"2023","journal-title":"Crit. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1186\/s13054-023-04612-5","article-title":"The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: A multicenter observational study","volume":"27","author":"Raasveld","year":"2023","journal-title":"Crit. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1111\/aas.14115","article-title":"Mortality and adverse events of hemoadsorption with CytoSorb\u00ae in critically ill patients: A systematic review and meta-analysis of randomized controlled trials","volume":"66","author":"Heymann","year":"2022","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1007\/s00134-021-06487-y","article-title":"No clinically relevant removal of meropenem by cytokine adsorber CytoSorb\u00ae in critically ill patients with sepsis or septic shock","volume":"47","author":"Liebchen","year":"2021","journal-title":"Intensiv. Care Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Bottari, G., Goffredo, B.M., Marano, M., Maccarrone, C., Simeoli, R., Bianco, G., Vallesi, L., Beetham, J.C.C., Mazzeo, A.T., and Cappoli, A. (2023). Impact of Continuous Kidney Replacement Therapy and Hemoadsorption with CytoSorb on Antimicrobial Drug Removal in Critically Ill Children with Septic Shock: A Single-Center Prospective Study on a Pediatric Cohort. Antibiotics, 12.","DOI":"10.20944\/preprints202308.0533.v1"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Schneider, A.G., Andr\u00e9, P., Scheier, J., Schmidt, M., Ziervogel, H., Buclin, T., and Kindgen-Milles, D. (2021). Pharmacokinetics of anti-infective agents during CytoSorb hemoadsorption. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-89965-z"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40635-025-00716-0","article-title":"Impact of hemoadsorption with CytoSorb\u00ae on meropenem and piperacillin exposure in critically ill patients in a post-CKRT setup: A single-center, retrospective data analysis","volume":"13","author":"Asgarpur","year":"2025","journal-title":"Intensiv. Care Med. 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