Blood Purification and Mortality in Sepsis: A Meta-Analysis of Randomized Trials*
Open accessAbstract
OBJECTIVES: Although blood purification improves outcomes in animal studies of sepsis, results of clinical trials have been mixed. We conducted a systematic review and meta-analysis of randomized trials to determine the association between various blood purification techniques and all-cause mortality in humans with sepsis. DATA SOURCES: We searched for relevant studies in MEDLINE, EMBASE, and the Cochrane Library database from January 1966 to May 2012. STUDY SELECTION: Inclusion required a diagnosis of sepsis and comparison of blood purification techniques including hemofiltration, hemoperfusion, plasma exchange, or hemodialysis with no blood purification (control group). DATA EXTRACTION: Two authors independently selected studies and extracted data. Summary statistics, risk ratios, and CIs were calculated using random-effects modeling. Study quality was assessed using Jadad score, and publication bias was assessed using funnel plots and Egger's statistic. DATA SYNTHESIS: Overall, blood purification decreased mortality compared with no blood purification (35.7% vs 50.1%; risk ratio, 0.69 [95% CI, 0.56-0.84]; p<0.001; 16 trials, n=827). However, these results were driven mainly by hemoperfusion (risk ratio, 0.63 [95% CI, 0.50-0.80]; p<0.001; 10 trials, n=557) and plasma exchange (risk ratio, 0.63 [95% CI, 0.42-0.96]; p=0.03; two trials, n=128). Pooling of all trials of blood purification for treatment of sepsis was no longer associated with lower mortality (risk ratio, 0.89 [95% CI, 0.71-1.13]; p=0.36; eight trials, n=457) after excluding trials using polymyxin B hemoperfusion. CONCLUSIONS: Blood purification techniques including hemoperfusion, plasma exchange, and hemofiltration with hemoperfusion were associated with lower mortality in patients with sepsis. These results were mainly influenced by studies using polymyxin B hemoperfusion from Japan.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Randomised trials of this technique have been previously summarised in a systematic review and meta-analysis.
“Randomised trials of this technique have been previously summarised in a systematic review and meta-analysis [482].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [482]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552 · see citing works
Assessing the quality of reports of randomized clinical trials: Is blinding necessary?
Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J. M., Gavaghan, D. J., & McQuay, H. J. (1996) · Controlled Clinical Trials · doi:10.1016/0197-2456(95)00134-4 · Cited by 17,582 · see citing works
Bone, R. C., BALK, R. A., Cerra, F. B., Dellinger, R. P., Fein, A. M., Knaus, W. A., Schein, R. M. H., & Sibbald, W. J. (1992) · CHEST Journal · doi:10.1378/chest.101.6.1644 · Cited by 13,192 · see citing works
Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010) · International Journal of Surgery · doi:10.1016/j.ijsu.2010.02.007 · Cited by 12,156 · see citing works
Angus, D. C., Linde-Zwirble, W. T., Lidicker, J., Clermont, G., Carcillo, J., & Pinsky, M. R. (2001) · Critical Care Medicine · doi:10.1097/00003246-200107000-00002 · Cited by 8,503 · see citing works
Dellinger, R. P., Levy, M. M., Carlet, J. M., Bion, J., Parker, M. M., Jaeschke, R., Reinhart, K., Angus, D. C., Brun‐Buisson, C., Beale, R. J., et al. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0934-2 · Cited by 6,722 · see citing works
The epidemiology of sepsis in the United States from 1979 through 2000
Martin, G. S., Mannino, D. M., Eaton, S., & Moss, M. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022139 · Cited by 5,841 · see citing works
Immunosuppression in Patients Who Die of Sepsis and Multiple Organ Failure
Boomer, J. S., To, K. B., Chang, K. C., Takasu, O., Osborne, D. F., Walton, A. H., Bricker, T. L., Jarman, S. D., Kreisel, D., Krupnick, A. S., et al. (2011) · JAMA · doi:10.1001/jama.2011.1829 · Cited by 1,789 · see citing works
Discrepancies between Meta-Analyses and Subsequent Large Randomized, Controlled Trials
LeLorier, J., Grégoire, G., Benhaddad, A. A., Lapierre, J., & Derderian, F. (1997) · New England Journal of Medicine · doi:10.1056/nejm199708213370806 · Cited by 1,171 · see citing works
Gogos, C. A., Drosou, E., Bassaris, H. P., & Skoutelis, A. (2000) · The Journal of Infectious Diseases · doi:10.1086/315214 · Cited by 883 · see citing works
Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock
Cruz, D. N., Antonelli, M. M., Fumagalli, R., Foltran, F., Brienza, N., Donati, A., Malcangi, V., Petrini, F., Volta, G., Pallavicini, F. M. B., et al. (2009) · JAMA · doi:10.1001/jama.2009.856 · Cited by 841 · see citing works
Understanding the Inflammatory Cytokine Response in Pneumonia and Sepsis
Kellum, J. A. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.15.1655 · Cited by 818 · see citing works
Self-citationPlasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial
Busund, R., Kuklin, V. N., Utrobin, U., & Nedashkovsky, E. V. (2002) · Intensive Care Medicine · doi:10.1007/s00134-002-1410-7 · Cited by 561 · see citing works
A pilot study of coupled plasma filtration with adsorption in septic shock*
Ronco, C., Brendolan, A., Lonnemann, G., et al. (2002) · Critical Care Medicine · doi:10.1097/00003246-200206000-00015 · Cited by 481 · see citing works
Honoré, P. M., Jamez, J., Wauthier, M., Lee, P. A., Dugernier, T., Pirenne, B., Hanique, G., & Matson, J. R. (2000) · Critical Care Medicine · doi:10.1097/00003246-200011000-00001 · Cited by 425 · see citing works
Vincent, J., Laterre, P., Cohen, J., et al. (2005) · Shock · doi:10.1097/01.shk.0000159930.87737.8a · Cited by 297 · see citing works
Payen, D. M., Matéo, J., Cavaillon, J. M., Fraisse, F., Floriot, C., & Vicaut, É. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181962316 · Cited by 294 · see citing works
A phase II randomized, controlled trial of continuous hemofiltration in sepsis
Cole, L., Bellomo, R., Hart, G. K., et al. (2002) · Critical Care Medicine · doi:10.1097/00003246-200201000-00016 · Cited by 292 · see citing works
Continuous plasmafiltration in sepsis syndrome
Reeves, J. H., Butt, W. W., Shann, F. A., et al. (1999) · Critical Care Medicine · doi:10.1097/00003246-199910000-00003 · Cited by 222 · see citing works
Morgera, S., Haase, M., Kuss, T., et al. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000229147.50592.f9 · Cited by 204 · see citing works
High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock
Cornejo, R., Downey, P., Castro, R., Romero, C. M., Regueira, T., Vega, J. E., Castillo, L., Andresen, M., Dougnac, A., Bugedo, G. J., et al. (2006) · Intensive Care Medicine · doi:10.1007/s00134-006-0118-5 · Cited by 151 · see citing works
Boussekey, N., Chiche, A., Faure, K., et al. (2008) · Intensive Care Medicine · doi:10.1007/s00134-008-1127-3 · Cited by 130 · see citing works
Newly Developed Immobilized Polymyxin B Fibers Improve the Survival of Patients with Sepsis
Nemoto, H., Nakamoto, H., Okada, H., Sugahara, S., Moriwaki, K., Arai, M., Kanno, Y., & Suzuki, H. (2001) · Blood Purification · doi:10.1159/000046966 · Cited by 115 · see citing works
Bellomo, R., Kellum, J. A., Gandhi, C. R., et al. (2000) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.161.5.9809127 · Cited by 110 · see citing works
Self-citationHigh-dose renal replacement therapy for acute kidney injury: Systematic review and meta-analysis
Wert, R. V., Friedrich, J. O., Scales, D. C., et al. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181d9d912 · Cited by 102 · see citing works
Huang, Z., Wang, S., Su, W., et al. (2010) · Therapeutic Apheresis and Dialysis · doi:10.1111/j.1744-9987.2010.00825.x · Cited by 98 · see citing works
Peng, Z.-Y., Wang, H.-Z., Carter, M. J., et al. (2011) · Kidney International · doi:10.1038/ki.2011.320 · Cited by 96 · see citing works
Self-citationGhani, R. A., ZAINUDIN, S., Kong, N. C. T., RAHMAN, A. F. A., WAFA, S. R. W. S. H., Mohamad, M. S. F., Manaf, M. R. A., & ISMAIL, R. (2006) · Nephrology · doi:10.1111/j.1440-1797.2006.00600.x · Cited by 91 · see citing works
Lin, Y., Ko, W., Chu, T., Chen, Y., Wu, V., Chen, Y., Wu, M., Chen, Y.-W., Tsai, C.-W., Shiao, C., et al. (2009) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2008.10.021 · Cited by 89 · see citing works
High-Volume Hemofiltration in Sepsis and SIRS: Current Concepts and Future Prospects
Honoré, P. M., Joannès-Boyau, O., Boer, W., & Collin, V. (2009) · Blood Purification · doi:10.1159/000210031 · Cited by 86 · see citing works
Intensities of Renal Replacement Therapy in Acute Kidney Injury
Jun, M., Heerspink, H. J. L., Ninomiya, T., Gallagher, M., Bellomo, R., Myburgh, J., Finfer, S. R., Palevsky, P. M., Kellum, J. A., Perkovic, V., et al. (2010) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.09111209 · Cited by 83 · see citing works
Self-citationReinhart, K., Meier‐Hellmann, A., Beale, R. J., et al. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000132902.54925.b5 · Cited by 81 · see citing works
Nakamura, T., Ebihara, I., Shoji, H., Ushiyama, C., Suzuki, S., & Koide, H. (1999) · Inflammation Research · doi:10.1007/s000110050442 · Cited by 76 · see citing works
Joannidis, M. (2009) · Seminars in Dialysis · doi:10.1111/j.1525-139x.2008.00552.x · Cited by 73 · see citing works
Langgartner, J., Vasold, A., Glück, T., Reng, M., & Kees, F. (2008) · Intensive Care Medicine · doi:10.1007/s00134-008-1034-7 · Cited by 63 · see citing works
Peng, Y., Yuan, Z., & Li, H. (2005) · Burns · doi:10.1016/j.burns.2005.02.004 · Cited by 61 · see citing works
A Pilot Study of High-Adsorption Hemofiltration in Human Septic Shock
Haase, M., Silvester, W., Uchino, S., et al. (2007) · The International Journal of Artificial Organs · doi:10.1177/039139880703000205 · Cited by 47 · see citing works
International Differences in the Treatment of Sepsis
Kellum, J. A., & Uchino, S. (2009) · JAMA · doi:10.1001/jama.2009.850 · Cited by 38 · see citing works
Self-citationBrar, H., Olivier, J., LeBrun, C. J., et al. (2008) · The American Journal of the Medical Sciences · doi:10.1097/maj.0b013e3181571f56 · Cited by 37 · see citing works
Nakamura, T., Ushiyama, C., Suzuki, Y., et al. (2003) · Journal of Hospital Infection · doi:10.1053/jhin.2002.1332 · Cited by 37 · see citing works
Zhang, P., Pai, P., Han-Min, W., et al. (2010) · The International Journal of Artificial Organs · doi:10.1177/039139881003300801 · Cited by 35 · see citing works
Sakamoto, Y., Mashiko, K., Obata, T., et al. (2008) · ASAIO Journal · doi:10.1097/mat.0b013e31815d2f01 · Cited by 31 · see citing works
Nakamura, T., Ushiyama, C., Suzuki, Y., et al. (2002) · ASAIO Journal · doi:10.1097/00002480-200205000-00008 · Cited by 25 · see citing works
Effect of polymyxin B-immobilized fiber on bone resorption in patients with sepsis
Nakamura, T., Kawagoe, Y., Matsuda, T., et al. (2004) · Intensive Care Medicine · doi:10.1007/s00134-004-2357-7 · Cited by 25 · see citing works
Nakamura, T., Ushiyama, C., Suzuki, Y., et al. (2003) · Nephron Clinical Practice · doi:10.1159/000071279 · Cited by 25 · see citing works
Role of the kidney in plasma cytokine removal in sepsis syndrome: a pilot study
Graziani, G., Bordone, G., Bellato, V., et al. (2006) · Journal of Nephrology · doi:10.1093/joneph/19.2.176 · Cited by 19 · see citing works
Yonekawa, C., Nakae, H., Tajimi, K., et al. (2006) · Therapeutic Apheresis and Dialysis · doi:10.1111/j.1744-9987.2006.00341.x · Cited by 7 · see citing works
ASSESSMENT OF PUBLICATION BIAS
Shaw, R. J., McDuffie, J. R., Hendrix, C. C., et al. (2013) · Cited by 3 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4683-6 · Cited by 6,621 · see citing works
Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002255 · Cited by 3,652 · see citing works
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082 · see citing works
The Role of Plasmapheresis in Critical Illness
Nguyen, T. C., Kiss, J. E., Goldman, J. R., & Carcillo, J. A. (2012) · Critical Care Clinics · doi:10.1016/j.ccc.2012.04.009 · Cited by 83 · see citing works
- Authors
- Zhou, F., Peng, Z., Murugan, R., & Kellum, J. A.
- Affiliations
- University of Pittsburgh (US)
- Venue
- Critical Care Medicine
- Published
- 2013-09
- Volume
- 41
- Issue
- 9
- Pages
- 2209-2220
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC3758418
- OpenAlex
- W2089094816
- Cited by
- 189
- References
- 51
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 10 · 2023: 12 · 2022: 12 · 2021: 13 · 2020: 15 · 2019: 14 · 2018: 18 · 2017: 27 · 2016: 13 · 2015: 17 · 2014: 17 · 2013: 4 · 2012: 1
- FWCI
- 2.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000005)
- National Heart, Lung, and Blood Institute (R01HL080926)
- National Center for Research Resources (KL2RR024154)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Keywords
- sepsis, blood purification, all-cause mortality, hemoperfusion, plasma exchange, hemofiltration, hemodialysis, polymyxin B hemoperfusion, extracorporeal blood purification
- MeSH terms
- Cause of Death, Humans, Randomized Controlled Trials as Topic, Sorption Detoxification, Sepsis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
