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CytoSorb in patients with coronavirus disease 2019: A rapid evidence review and meta-analysis
Shilin Wei1,2, Yanchun Zhang3, Kerong Zhai1,2
1Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
Insights
CytoSorb therapy in COVID-19 patients showed a 42.1% in-hospital mortality rate, with significant reductions in C-reactive protein and interleukin-6 levels. Many patients also required extracorporeal membrane oxygenation support.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Biomedical Engineering
Background:
- CytoSorb therapy, approved in 2011, aims to mitigate cytokine storms by reducing inflammatory mediators.
- Its efficacy in treating patients with coronavirus disease (COVID-19) remains incompletely understood.
- This study systematically reviews and meta-analyzes existing evidence to guide clinical practice and future research.
Approach:
- A systematic literature search was conducted across major databases (Cochrane Library, Embase, PubMed, ICTRP) for studies published between December 1, 2019, and December 31, 2021.
- Random-effects meta-analyses were performed using R software (3.6.1) to pool data from 14 studies involving 241 COVID-19 patients treated with CytoSorb hemadsorption.
- The Joanna Briggs Institute checklist was used for bias assessment, with results presented as pooled proportions and means with 95% confidence intervals.
Key Points:
- The pooled in-hospital mortality rate for COVID-19 patients treated with CytoSorb was 42.1% (95% CI 29.5-54.6%).
- A significant proportion of patients (73.2%) received adjunctive extracorporeal membrane oxygenation (ECMO) support.
- CytoSorb treatment led to a reduction in C-reactive protein (CRP) and interleukin-6 (IL-6) levels.
Conclusions:
- CytoSorb treatment in COVID-19 patients was associated with a 42.1% in-hospital mortality rate.
- The majority of treated patients required extracorporeal membrane oxygenation (ECMO) support.
- Post-treatment analysis indicated a decrease in both C-reactive protein and interleukin-6 levels.
Background:
After its approval by the European Union in 2011, CytoSorb therapy has been applied to control cytokine storm and lower the increased levels of cytokines and other inflammatory mediators in blood. However, the efficiency of this CytoSorb treatment in patients with coronavirus disease (COVID-19) still remains unclear. To elucidate the Cytosorb efficiency, we conducted a systematic review and single-arm proportion meta-analysis to combine all evidence available in the published literature to date, so that this comprehensive knowledge can guide clinical decision-making and future research.
Methods:
The literature published within the period 1 December 2019 to 31 December 2021 and stored in the Cochrane Library, Embase, PubMed, and International Clinical Trials Registry Platform (ICTRP) was searched for all relevant studies including the cases where COVID-19 patients were treated with CytoSorb. We performed random-effects meta-analyses by R software (3.6.1) and used the Joanna Briggs Institute checklist to assess the risk of bias. Both categorical and continuous variables were presented with 95% confidence intervals (CIs) as pooled proportions for categorical variables and pooled means for continuous outcomes.
Results:
We included 14 studies with 241 COVID-19 patients treated with CytoSorb hemadsorption. Our findings reveal that for COVID-19 patients receiving CytoSorb treatment, the combined in-hospital mortality was 42.1% (95% CI 29.5-54.6%, I2 = 74%). The pooled incidence of adjunctive extracorporeal membrane oxygenation (ECMO) support was 73.2%. Both the C-reactive protein (CRP) and interleukin-6 (IL-6) levels decreased after CytoSorb treatment. The pooled mean of the CRP level decreased from 147.55 (95% CI 91.14-203.96) to 92.36 mg/L (95% CI 46.74-137.98), while that of IL-6 decreased from 339.49 (95% CI 164.35-514.63) to 168.83 pg/mL (95% CI 82.22-255.45).
Conclusions:
The majority of the COVID-19 patients treated with CytoSorb received ECMO support. In-hospital mortality was 42.1% for the COVID-19 patients who had CytoSorb treatment. Both CRP and IL-6 levels decreased after Cytosorb treatment.
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