The Effect of Extracorporeal Hemopurification Combined With Conventional Anti-Infection on Clinical Prognosis and Immune Function in Sepsis: A Meta-Analysis.

Aims/Background Sepsis remains a major cause of mortality in intensive care units (ICUs) worldwide, with conventional treatments showing limited efficacy. Extracorporeal hemopurification (EH) techniques have emerged as promising adjunctive therapies. This study aims to explore the impact of EH techniques, including hemofiltration, hemoperfusion, hemodialysis, and hemosorption, on the clinical prognosis and immune function of patients with sepsis. Methods We searched relevant literature describing patients with a precise clinical diagnosis of sepsis, severe sepsis, or septic shock across various databases, including MEDLINE, AMED, Cochrane Library, Embase, PubMed, China National Knowledge Infrastructure (CNKI), Weipu, and Wanfang, published from January 2010 to October 2023. Both randomized controlled trials and observational studies were included to compare those receiving EH and conventional anti-infective treatment. Meta-analysis was performed using RevMan 5.3 software after two evaluators independently screened the literature, extracted information, and evaluated the methodological quality of the included studies. The primary outcome indicators included in-hospital mortality (IHM) and length of ICU stay (LOS-ICU). Furthermore, the changes in T-helper 1/T-helper 2 (Th1/Th2) levels were analyzed and expressed as relative risk (RR), odds ratio (OR), or mean difference (MD) with corresponding 95% confidence interval (CI) as appropriate for the type of outcome measure. Results This analysis included 30 studies (n = 2262) (1267 in the EH group and 995 in the conventional treatment group). We observed that EH treatment, such as hemopurification, hemofiltration, hemoperfusion, hemodialysis, and hemoadsorption, significantly reduced IHM in sepsis patients (RR = 0.75, 95% CI: 0.68-0.84, p < 0.00001). However, there was no significant impact on LOS-ICU (MD = -0.44, 95% CI: -2.29-1.41, p = 0.64). Subgroup analyses suggested that cytokine adsorption (OR = 0.69, p = 0.17) or polymyxin B blood perfusion (OR = 0.73, p = 0.06) did not reduce IHM in sepsis patients. Similarly, EH did not improve IHM in patients with septic acute renal failure (RR = 0.82, p = 0.27) and IHM in patients with burn-induced sepsis (RR = 0.59, p = 0.07). For sepsis patients with improved Th1/Th2 value of immune factor levels by EH, IHM was not significantly reduced (RR = 0.61, p = 0.08), and LOS-ICU also showed no significant difference (MD = 0.34, 95% CI: -5.92-6.60, p = 0.92). Conclusion For sepsis patients without relevant contraindications, EH holds promise as an adjunctive therapy, but the modulation of immune factor levels during treatment does not consistently influence the LOS-ICU.