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

Abstract

Background The 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. Methods Eleven 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. Results The 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. Conclusion The 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.

Continuous veno-venous hemofiltration with oXiris hemofilters for the treatment of Fournier's gangrene: A case report series

“…3 A&B&C).These findings are in line with other reported cases [ 17 , 18 , 20 ]. Recent meta-analysis shows oXiris reduces sepsis 28-day mortality, ICU days, improves SOFA scores, lowers norepinephrine, IL-6, and lactate [ 28 , 29 ]. This aligns with our study findings.…”

Septic Hyperinflammation—Is There a Role for Extracorporeal Blood Purification Techniques?

“…A recent meta-analysis, which compiled clinical data from 10 cohort studies and 4 RCTs encompassing 695 patients with sepsis undergoing CRRT, suggested potentially positive effects on 7-, 14-, and 28-day mortality, SOFA score, catecholamine requirement, lactate level, and length of ICU stay [ 43 ]. However, the quality of the studies included was not sufficient to draw definitive conclusions.…”

Bias and potential premature conclusions regarding the clinical benefits of oXiris in septic adult patients

“…It is worth noting that the primary result from Wang et al [ 1 ] heavily relies on retrospective studies, raising concerns about the possibility of publication bias, as negative results from retrospective cohort studies might not have been published. Additionally, half of the enrolled studies (7 out of 14 enrolled trials) did not report the 28-day mortality outcome.…”

“…It is highly encouraged to validate the impact of oXiris using evidence-based medicine methodologies. We carefully reviewed the recently published systematic review by Wang et al [ 1 ] and found it to be highly intriguing. A significant reduction with a substantial effect in 28-day mortality (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.36–0.77, I 2 = 8%), which is considered one of the critical endpoints, was observed through meta-analysis using data from 7 out of 14 enrolled studies.…”