The Efficacy of Hemoperfusion in Severe COVID-19 Patients: A Systematic Review and Meta-Analysis.

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2025-05-14 DOI:10.1159/000546256

Song Shang, Bin Zhang, Baofa Wu, Yaping Dou, Lihai Zhang, Wuzhuang Sun

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引用次数: 0

Abstract

Introduction: This study aimed to conduct a meta-analysis and systematic review to assess the efficacy of hemoperfusion (HP) in patients with severe coronavirus disease 2019 (COVID-19).

Methods: A comprehensive search for candidate publications was performed using PubMed, Cochrane Library, and Embase. Studies investigating the effect of HP on mortality among severe COVID-19 patients were selected, including randomized controlled trials (RCTs), non-RCTs, and observational studies with control groups. The primary endpoint was the longest reported mortality, while the secondary endpoints were the length of stay, intensive care unit (ICU) stay, P/F ratio, and C-reactive protein (CRP). The Cochrane test (Q) and I2 test were used to quantify heterogeneity among the studies. The fixed-effect model (Mantel-Haenszel method) would be selected when there is no heterogeneity (p > 0.10 and I2 <50%), whereas the random-effect model (DerSimonian-Laird method) was used in obvious heterogeneity (p ≤ 0.10 and I2 ≥50%). Data are presented as risk ratio (RR), 95% confidence intervals (CIs), p values, and I2.

Results: Of the 127 articles retrieved, 14 were selected for this study, including 405 patients in the HP group and 518 patients in the control group. There was no statistically significant difference in mortality between the HP and the control groups (RR 0.81 95% CI: [0.71, 0.93]; p = 0.15 > 0.05; I2 = 68.2%). The results of the subgroup analysis of HP with HA series indicated a reduction in the mortality of patients with COVID-19 (RR 0.60 [0.46, 0.78]; p < 0.0001; I2 = 0.0%). The HP group had a longer hospital stay compared with the control group (weighted mean difference; WMD 5.25 [2.53, 7.97] days; p < 0.05; I2 = 28.0%), but not the ICU stay (ES 1.33 [-2.86, 5.53] days; p = 0.53; I2 = 85.5%). After HP, the P/F ratio (WMD 95.79 [74.46, 117.12] mm Hg; p < 0.05; I2 = 5.8%) increased, while CRP (WMD -44.03 [-68.97, -19.09] mg/L; p < 0.05; I2 = 86.9%) decreased.

Conclusion: This study found that HP did not significantly reduce mortality in COVID-19 patients; however, the HA series showed potential mortality benefits, suggesting its clinical applicability. While the HP group had longer hospital stays, ICU stay durations did not differ significantly. Notably, HP improved the P/F ratio and reduced CRP levels post-treatment.

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血液灌流治疗重症COVID-19患者的疗效：系统回顾和荟萃分析。

目的：本研究旨在通过荟萃分析和系统评价血液灌流治疗重症COVID-19患者的疗效。数据来源：使用PubMed、Cochrane Library和Embase对候选出版物进行全面搜索。研究选择：选择研究血液灌流对COVID-19重症患者死亡率影响的研究，包括随机对照试验（rct）、非随机对照试验和对照组观察性研究。主要终点是报告的最长死亡率，而次要终点是住院时间、ICU住院时间、P/F比和CRP。资料提取：采用Cochrane检验(Q)和issquared检验（I2）来量化研究间的异质性。当不存在异质性（P≤0.10,I2 < 50%）时采用固定效应模型（Mantel-Haenszel法），当异质性明显（P≤0.10,I2≥50%）时采用随机效应模型（dersimonan - laird法）。数据以风险比（RR）表示；95%置信区间（ci）；p值;I2。数据综合：在检索到的127篇文献中，选择了14篇用于本研究，其中HP组405例，对照组518例。血液灌流组与对照组的死亡率差异无统计学意义(RR = 0.81, 95%CI[0.71, 0.93]；P = 0.15 > 0.05；I2 = 68.2%)。HA系列血液灌流亚组分析结果显示COVID-19患者死亡率降低(RR 0.60 [0.46, 0.78]；P < 0.0001；I2 = 0.0%)。与对照组相比，HP组患者住院时间更长(WMD为5.25[2.53,7.97]d；P < 0.05；I2 = 28.0%)，但ICU住院天数差异无统计学意义(ES 1.33[-2.86, 5.53]d；P = 0.53；I2 = 85.5%)。血液灌流后P/F比值(WMD 95.79[74.46, 117.12]mmHg；P < 0.05；I2 = 5.8%)升高，CRP (WMD -44.03[-68.97, -19.09]mg/L；P < 0.05；I2 = 86.9%)下降。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.