The Effects of Continuous Blood Purification for SIRS/MODS Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

Background. Continuous veno-venous hemofiltration (CVVH) has aroused great concern in recent years because its effect on clearing inflammatory mediators and its mechanism of clinical effects in the treatment of critical illness has also become a research direction. Objective. To evaluate the efficacy of continuous blood purification for systemic inflammatory response syndrome (SIRS)/multiple organ dysfunction syndrome (MODS) patients. Methods. A systematic review of the literature was undertaken to assess randomized controlled trials on CVVH. Results. 11 RCTs involving a total of 414 patients were included. Compared with the control group, CVVH for SIRS/MODS patients has several advantages including better effects on clearing the plasma inflammatory mediators IL-6 [SMD(3d) = -0.45, 95%CI, (-0.83, -0.07), SMD(7d) = -1.07, 95%CI, (-1.52, -0.62)], on plasma TNF-alfa [SMD(3d) = -0.87, 95%CI, (-1.69, -0.04), SMD(7d) = -1.42, 95%CI, (-2.49, -0.35)], lower white blood cell (WBC) count [MD = 2.61, 95%CI, (1.49, 3.73)], shorter hospital stays [MD = -7.21 days, 95%CI, (-10.68, -3.74)] and better stability of hemodynamics. However, there is no significant difference in the mortality rate [MODS:RR = 0.62, 95%CI, (0.38, 1.01), SIRS:RR = 0.75, 95%CI, (0.57, 1.08)]. Conclusions. The study showed that CVVH was able to eliminate inflammatory mediators (TNF-alfa, IL-6) in plasma effectively, lower WBC count and shorter hospital stays than conventional therapeutic measures.