The Effects of CytoSorb in Critically Ill Adult Patients on Vasopressor Support: A Systematic Review and Meta-Analysis.

BACKGROUND

The impact of CytoSorb hemoadsorption on hemodynamic stability, mortality, and intensive care unit length of stay in critically ill adult patients requiring vasopressor support is unclear.

METHODS

Systematic review and meta-analysis of randomized controlled trials and observational studies, enrolling adult intensive care unit patients requiring vasopressor support. We compared CytoSorb hemoadsorption versus standard care or control interventions.

RESULTS

Twelve studies enrolling 568 patients met the inclusion criteria. Primary outcomes included noradrenaline dosage, mortality at longest follow-up, and intensive care unit length of stay. CytoSorb treatment significantly reduced noradrenaline requirements (mean difference -0.08 μg/kg/min [95% CI: -0.15 to -0.02], p = 0.02, I2 = 8%). Mortality at the longest follow-up was lower with CytoSorb (risk ratio 0.66 [95% CI: 0.55-0.80], p < 0.001, I2 = 0%), though this finding was driven primarily by observational studies; randomized controlled trials alone showed non-significant mortality reduction (risk ratio 0.23 [95% CI: 0.05-1.06], p = 0.06). No difference in intensive care unit length of stay was observed (mean difference 0.24 days [95% CI: -1.23 to 1.70], p = 0.75). Trial sequential analysis indicated insufficient information size for definitive conclusions. Overall evidence quality was low to very low.

CONCLUSIONS

CytoSorb hemoadsorption may reduce vasopressor requirements in critically ill patients. Observed mortality benefits were driven primarily by observational studies, with RCTs showing non-significant trends. Overall evidence quality is low, and findings should be considered hypothesis-generating; adequately powered RCTs are needed before clinical recommendations can be made.