Journal of Clinical Medicine

Research

12 pages, 813 KB

Open AccessArticle

Hemodynamic Effect of IgM-Enriched Immunoglobulin in the Early Stage of E. coli-Induced Experimental Sepsis

by Balázs Ujhelyi, Ádám Attila Mátrai, Mariann Berhés, Luca Panka Molnár, Ádám Deák, Zoltán Tóth, István László, Norbert Németh and Béla Fülesdi

J. Clin. Med. 2026, 15(4), 1522; https://doi.org/10.3390/jcm15041522 - 14 Feb 2026

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Abstract

Background: Current sepsis guidelines recommend the best supportive treatment for severe sepsis, but they are limited on the effectiveness of immunomodulatory therapies. Recent data suggest that IgM-enriched immunoglobulin preparations may decrease mortality, but the exact pathomechanism remains unknown. The present experimental study aims [...] Read more.

Background: Current sepsis guidelines recommend the best supportive treatment for severe sepsis, but they are limited on the effectiveness of immunomodulatory therapies. Recent data suggest that IgM-enriched immunoglobulin preparations may decrease mortality, but the exact pathomechanism remains unknown. The present experimental study aims to test the hypothesis that IgM-enriched immunoglobulin may improve hemodynamics in E-coli-induced severe sepsis. Subjects and methods: Sepsis was induced in the E. coli bacteriemia (n = 8), E. coli-parallel Pentaglobin treatment (PR-PG; n = 8), and E. coli-delayed Pentaglobin treatment (D-PG; n = 8). Sepsis was induced in the sepsis, PR-PG, and D-PG groups by infusing 38 mL of an E. coli suspension (2.5 × 10⁵/mL) over 3 h. The PR-PG group received a 0.75 g/kg Pentaglobin bolus over 20 min concurrently with the start of E. coli infusion. The D-PG group was given a 0.67 g/kg Pentaglobin bolus one hour after starting E. coli, followed by a continuous infusion at 0.02 g/kg/h for 240 min. Hemodynamic parameters were monitored every 2 h using a pulse contour cardiac output monitoring technique (PiCCo™). Results: Heart rate increased in all groups to varying extents. Mean arterial pressure (MAP) remained stable in controls but declined in untreated sepsis. Both Pentaglobin-treated groups showed higher MAP than untreated septic animals. Mild cardiac index increases occurred in controls and untreated sepsis, whereas the treated groups maintained a consistently elevated CI after Pentaglobin administration. Systemic vascular resistance index (SVRI) transiently increased in controls before normalizing, while untreated septic animals experienced continuous SVRI decline. Treated animals showed an initial transient SVRI rise followed by a decline; yet, SVRI remained higher than in untreated sepsis. Conclusions: IgM-enriched immunoglobulin led to a slight stabilization of some hemodynamic parameters, probably due to the reduced extpnfiravasation of fluids into the interstitium and, hence, had an effect on preload. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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12 pages, 703 KB

Open AccessArticle

Early Identification of Sepsis by Emergency Medical Services: Diagnostic Accuracy of Scoring Systems in a Retrospective Cohort

by Andrea Kornfehl, David Mickerts, Mario Krammel, David Hauer and Sebastian Schnaubelt

J. Clin. Med. 2026, 15(2), 827; https://doi.org/10.3390/jcm15020827 - 20 Jan 2026

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Abstract

Background/Objectives: Emergency Medical Services (EMSs) frequently provide the first medical contact for sepsis patients, but recognition is challenging. This study thus aimed to determine how often EMSs suspect sepsis and to evaluate the diagnostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA), [...] Read more.

Background/Objectives: Emergency Medical Services (EMSs) frequently provide the first medical contact for sepsis patients, but recognition is challenging. This study thus aimed to determine how often EMSs suspect sepsis and to evaluate the diagnostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA), the Prehospital Early Sepsis Detection (PRESEP) score, and the Modified Early Warning Score (MEWS). Methods: A retrospective observational study of all EMS transports to one emergency department during a one-month period in 2023 was conducted. Prehospital vital signs, EMS working diagnoses, and final in-hospital diagnoses were abstracted. Scores were calculated post hoc. The primary outcome was the diagnostic accuracy of the EMSs’ working diagnosis of “suspected sepsis.” Secondary outcomes included the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of qSOFA, PRESEP, and MEWS. Results: Among 786 EMS encounters, 597 met the inclusion criteria. Twelve patients (2.0%) were ultimately diagnosed with sepsis. EMSs explicitly suspected sepsis in three of them (25.0%; sensitivity 16.7%, specificity 99.8%). Retrospective application of scores yielded markedly higher sensitivity: qSOFA 83.3%, PRESEP 91.7%, and MEWS 83.3%. Specificities were 74.2% for qSOFA, 41.2% for PRESEP, and 77.6% for MEWS. The AUCs were 0.838 for qSOFA, 0.695 for PRESEP, and 0.863 for MEWS, with MEWS significantly outperforming PRESEP (p = 0.0215). Conclusions: EMS personnel rarely labeled patients with sepsis, recognizing 3 of 12 cases (25%). Retrospective use of scoring systems based on routine vital signs substantially improved diagnostic accuracy, with MEWS performing best overall. Structured screening tools should be prospectively validated and potentially implemented in EMS. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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16 pages, 1321 KB

Open AccessArticle

“Lost in Transition”: Informational Needs of Sepsis Survivors and Their Relatives Across the Care Trajectory—A Qualitative Study

by Frank Vahl, Susanne Ullmann, Lea Draeger, Lena Kannengießer, Mathias W. Pletz, Claudia T. Matthaeus-Kraemer and Carolin Fleischmann-Struzek

J. Clin. Med. 2026, 15(1), 91; https://doi.org/10.3390/jcm15010091 - 23 Dec 2025

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Abstract

Background/Objectives: Sepsis survivors frequently experience long-term complications known as Post-Sepsis Syndrome. Many survivors and their relatives express ongoing dissatisfaction with the quality and accessibility of health information. Yet the specific informational needs and preferred formats remain insufficiently defined. To identify the informational needs [...] Read more.

Background/Objectives: Sepsis survivors frequently experience long-term complications known as Post-Sepsis Syndrome. Many survivors and their relatives express ongoing dissatisfaction with the quality and accessibility of health information. Yet the specific informational needs and preferred formats remain insufficiently defined. To identify the informational needs of sepsis survivors and their relatives across different stages of illness and recovery. Methods: This qualitative study, conducted within the AVENIR project, included semi-structured telephone interviews with 12 survivors and 6 relatives in Germany. Interviews were transcribed verbatim and analyzed using qualitative content analysis according to Mayring. Results: Eighteen interviews highlighted phase-specific gaps in information. Relatives reported urgent needs for timely, comprehensible and empathetic communication during the ICU phase, often while under decision pressure. Survivors described limited capacity to process information during the acute phase and sought orientation only after cognitive and emotional stabilization. After discharge, both groups reported an “information vacuum”, marked by insufficient guidance on long-term physical and psychological consequences, rehabilitation, vaccination, and follow-up care. Many participants received no informational material, or only general or inconsistent information. Desired content emphasized basic sepsis knowledge, explanations of persistent symptoms, practical coping strategies, and navigation of support services. Preferred formats included peer support and repeated, personal conversations with healthcare professionals, complemented by trusted online and printed resources. Conclusions: Sepsis survivors and relatives experience notable, role- and phase-specific information deficits that extend from the ICU into long-term recovery. Timely, reliable, and accessible information may help reduce uncertainty, support coping, and strengthen autonomy for both survivors and relatives. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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10 pages, 334 KB

Open AccessArticle

The Impact of Age on In-Hospital Mortality in Patients with Sepsis: Findings from a Nationwide Study

by Ohad Gabay, Ruth Smadar-Shneyour, Shiloh Adi, Matthew Boyko, Yair Binyamin, Victor Novack and Amit Frenkel

J. Clin. Med. 2025, 14(21), 7637; https://doi.org/10.3390/jcm14217637 - 28 Oct 2025

Viewed by 1749

Abstract

Background: Age is a well-established determinant of sepsis outcomes, often integrated into severity scoring systems. However, most studies focus on critically ill patients in intensive care units (ICUs), with limited insight into how age influences mortality in non-ICU settings, particularly across the [...] Read more.

Background: Age is a well-established determinant of sepsis outcomes, often integrated into severity scoring systems. However, most studies focus on critically ill patients in intensive care units (ICUs), with limited insight into how age influences mortality in non-ICU settings, particularly across the full adult lifespan. Objective: To investigate the relationship between age and in-hospital mortality in patients with sepsis hospitalized in internal medicine wards, using age-stratified logistic and spline regression models. Methods: We conducted a retrospective, multicenter cohort study involving 4300 adult patients admitted to internal medicine wards at eight academic hospitals affiliated with Clalit Health Services in Israel between December 2001 and October 2020. All patients were diagnosed with sepsis during hospitalization and died during their hospital stay. Patients were stratified into seven age groups (18–34, 35–44, 45–54, 55–64, 65–74, 75–84, >85 years). Logistic regression identified age-specific comorbidities associated with mortality. Adjusted spline regression models were used to estimate mortality probabilities across age ranges. Results: The cohort had a mean age at death of 78.84 years, and 51.7% were female. Mortality probability increased with age but demonstrated non-linear trends. Sharp fluctuations in predicted mortality were observed in middle-aged groups (especially ages 45–54), with peaks not captured in conventional binary or linear models. Hematologic and solid neoplasms were strongly associated with mortality in younger groups, while cardiovascular comorbidities such as heart failure and atrial fibrillation were more prominent in older adults. Conclusions: Age is a major determinant of in-hospital mortality in septic patients on internal medicine wards, but its effect is non-linear and age-specific. Our findings highlight a unique population of patients with severe sepsis not managed in critical care settings and underscore the need for more nuanced, age-stratified risk assessment models outside of the ICU. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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12 pages, 906 KB

Open AccessArticle

Norepinephrine Onset Time and Mortality in Patients with Septic Shock Treated in the Emergency Department

by German Devia Jaramillo, Jose Wdroo Motta Hernández and William Gerardo Donoso Zapata

J. Clin. Med. 2025, 14(17), 6025; https://doi.org/10.3390/jcm14176025 - 26 Aug 2025

Cited by 1 | Viewed by 3690

Abstract

Introduction: Sepsis, and particularly septic shock, is a life-threatening condition associated with high mortality rates in the emergency department. Timely interventions can significantly reduce these unacceptably high mortality rates. While some studies have demonstrated reduced mortality with early norepinephrine initiation, there is limited [...] Read more.

Introduction: Sepsis, and particularly septic shock, is a life-threatening condition associated with high mortality rates in the emergency department. Timely interventions can significantly reduce these unacceptably high mortality rates. While some studies have demonstrated reduced mortality with early norepinephrine initiation, there is limited research on this intervention specifically within the emergency department setting. The objective of this study was to determine the association between the time to norepinephrine initiation in the emergency department and in-hospital mortality in adult patients diagnosed with septic shock. Methods: This retrospective cohort study included adult patients diagnosed with septic shock in the emergency department. Demographics, paraclinical variables, and the time to norepinephrine initiation were evaluated. In-hospital mortality was defined as the primary outcome. Finally, a multivariate analysis was performed to develop a nomogram for predicting septic shock mortality from the emergency department. Results: A total of 176 patients were included. A significant difference was documented between the time to norepinephrine initiation (in minutes) and survival rates: median (IQR) 12 (2–29) min for survivors versus 104 (68–181) min for non-survivors (p < 0.001). Similarly, when the time to initiation was divided into three groups (<60, 61–179, >179 min), a differential association with mortality was observed: OR 0.16 (95% CI; 0.08–0.32), OR 5.59 (95% CI; 2.67–11.6), and OR 353 (95% CI; 20.8–5978.9), respectively. Additionally, variables associated with mortality included mean arterial pressure, arterial lactate, and creatinine levels. Conclusions: Early initiation of norepinephrine in the emergency department may lower in-hospital mortality from septic shock without raising arrhythmia rates. Further high-quality studies are needed to confirm this and identify the patients who would benefit most. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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12 pages, 827 KB

Open AccessArticle

Evaluating Sepsis Mortality Predictions from the Emergency Department: A Retrospective Cohort Study Comparing qSOFA, the National Early Warning Score, and the International Early Warning Score

by German Alberto Devia-Jaramillo, Lilia Erazo-Guerrero, Vivian Laguado-Castro and Juan Manuel Alfonso-Parada

J. Clin. Med. 2025, 14(14), 4869; https://doi.org/10.3390/jcm14144869 - 9 Jul 2025

Cited by 4 | Viewed by 4649

Abstract

Introduction: Sepsis has a high mortality rate, especially in low-income countries. Improving outcomes depends on the early recognition of patients at risk of death. Therefore, rapid and applicable prediction scores are needed in emergency triage. Objective: This study assessed the effectiveness [...] Read more.

Introduction: Sepsis has a high mortality rate, especially in low-income countries. Improving outcomes depends on the early recognition of patients at risk of death. Therefore, rapid and applicable prediction scores are needed in emergency triage. Objective: This study assessed the effectiveness of the qSOFA, NEWS, and IEWS scales in predicting in-hospital mortality during emergency triage. Additionally, we analyzed the efficacy of the IEWS_L, which integrates the IEWS with arterial lactate levels measured upon admission to the emergency department. Method: This retrospective study included patients who consulted the emergency department with suspected sepsis, where various scoring systems were evaluated for their effectiveness. We evaluated the diagnostic capacity of the tests by measuring the specificity, sensitivity, positive and negative predictive values, as well as the areas under the curve (AUC) of each score to predict mortality. Results: The study included 383 patients who had visited the emergency department. The overall mortality rate was 20.6%, and the mortality rate, precisely due to septic shock, was 35.2%. The AUC values for predicting in-hospital deaths due to sepsis were as follows: qSOFA: 0.68 (95% CI: 0.62–0.74); NEWS: 0.71 (95% CI: 0.64–0.77); IEWS: 0.74 (95% CI: 0.68–0.80); IEWS_L: 0.81 (95% CI: 0.76–0.86). Conclusions: In the emergency department, the IEWS scale demonstrated the best ability to accurately predict in-hospital mortality from sepsis when compared to the qSOFA and NEWS scale. Additionally, incorporating the serum lactate level into the IEWS scale significantly enhances its capacity to predict mortality. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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14 pages, 1491 KB

Open AccessArticle

Evaluation of Presepsin for Early Diagnosis of Sepsis in the Emergency Department

by Andrea Piccioni, Silvia Baroni, Gloria Rozzi, Fabio Belvederi, Simone Leggeri, Fabio Spagnuolo, Michela Novelli, Giulia Pignataro, Marcello Candelli, Marcello Covino, Antonio Gasbarrini and Francesco Franceschi

J. Clin. Med. 2025, 14(7), 2480; https://doi.org/10.3390/jcm14072480 - 4 Apr 2025

Cited by 11 | Viewed by 5048

Abstract

Background: to date, there are no specific markers available for diagnosing sepsis. Diagnosis is, indeed, mainly determined by clinical suspicion and the evaluation of the patient’s overall condition. This evaluation involves assessing various inflammatory markers, such as C-reactive protein (CRP) and procalcitonin [...] Read more.

Background: to date, there are no specific markers available for diagnosing sepsis. Diagnosis is, indeed, mainly determined by clinical suspicion and the evaluation of the patient’s overall condition. This evaluation involves assessing various inflammatory markers, such as C-reactive protein (CRP) and procalcitonin (PCT), along with markers of tissue hypoxia, such as serum lactate. Additionally, it includes scores that account for complete blood count (CBC), organ function markers, and the patient’s vital parameters, including SOFA, qSOFA, SIRS, and NEWS. Over the years, various potential biomarkers have been studied; among these presepsin appears to offer some significant advantages. Objective: Presepsin, which is the N-terminal fragment of the soluble component of CD14, is primarily elevated in infectious conditions. Its levels rise much earlier in the context of infection compared to currently used biomarkers. As a result, Presepsin shows promise for the early identification of septic patients and could aid in prognostic assessment, allowing clinicians to prioritize care for critically ill individuals. Methods: this study aims to evaluate the role of serum presepsin in the early diagnosis of sepsis in patients who present to the emergency room with a clinical suspicion of sepsis. The secondary objectives include comparing the diagnostic performance of presepsin with traditional biomarkers currently used for sepsis diagnosis and assessing its utility as a prognostic biomarker for mortality risk stratification, in comparison with validated severity prediction scores. Result: Presepsin had valuable diagnostic utility for sepsis (AUC 0.946, p < 0.001) comparable to PCT (AUC 0.905, p < 0.001). Conclusions: the combination of Presepsin, PCT, and EWS yielded the highest diagnostic accuracy for sepsis. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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Review

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15 pages, 682 KB

Open AccessReview

Presepsin as a Diagnostic and Prognostic Biomarker of Sepsis-Associated Acute Kidney Injury: A Scoping Review of Clinical Evidence

by Edmilson Leal Bastos de Moura, Dilson Palhares Ferreira and Rinaldo Wellerson Pereira

J. Clin. Med. 2025, 14(19), 6970; https://doi.org/10.3390/jcm14196970 - 1 Oct 2025

Cited by 1 | Viewed by 2108

Abstract

Sepsis is a complex clinical syndrome associated with high morbidity and mortality and organ dysfunction, most notably acute kidney injury. Early recognition determines crucial clinical decisions for septic individuals. This rapid diagnosis depends on the accuracy of biomarkers in the context of coexisting [...] Read more.

Sepsis is a complex clinical syndrome associated with high morbidity and mortality and organ dysfunction, most notably acute kidney injury. Early recognition determines crucial clinical decisions for septic individuals. This rapid diagnosis depends on the accuracy of biomarkers in the context of coexisting renal dysfunction. In this context, the value of presepsin has been investigated and challenged for a decade, with no definitive answers. This scoping review aims to evaluate the existing evidence regarding the accuracy of presepsin as a diagnostic and prognostic biomarker for sepsis-associated acute kidney injury (SA-AKI). We obtained 130 articles by searching for references in databases (PubMed/Medline, Web of Science, Embase, and Scopus) following the PRISMA-ScR guidelines. Sequential selection by three independent readers resulted in nine references retained for full analysis. Presepsin demonstrated good diagnostic and prognostic accuracy in patients with AKI, based on observations in small patient groups; however, it requires specific cutoff values, whose determination depends on new controlled and randomized studies. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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26 pages, 643 KB

Open AccessReview

The Fibrinolytic System in Bacterial Sepsis: A Comprehensive Review of Current Assessment Methods

by Florin Scarlatescu, Ecaterina Scarlatescu, Jecko Thachil, Dana R. Tomescu and Daniela Bartos

J. Clin. Med. 2025, 14(17), 6055; https://doi.org/10.3390/jcm14176055 - 27 Aug 2025

Cited by 3 | Viewed by 2171

Abstract

Background: Fibrinolytic impairment is one of the key factors involved in the pathogenesis of hemostasis disturbances in sepsis, significantly contributing to microthrombosis, organ dysfunction, and mortality rates. While hemostatic assessment in sepsis typically focuses on coagulation activation, evaluating fibrinolytic activity remains challenging due [...] Read more.

Background: Fibrinolytic impairment is one of the key factors involved in the pathogenesis of hemostasis disturbances in sepsis, significantly contributing to microthrombosis, organ dysfunction, and mortality rates. While hemostatic assessment in sepsis typically focuses on coagulation activation, evaluating fibrinolytic activity remains challenging due to methodological limitations and a lack of standardization of the currently available methods. Objectives: This comprehensive review examines current methods for assessing fibrinolytic activity in bacterial sepsis, their clinical applications, strengths and limitations, and future perspectives for improved diagnostic approaches. Methods: We conducted a systematic literature search and identified 52 studies that investigated fibrinolysis assessment in adult patients with bacterial sepsis using biomarkers or global tests. Studies included mainly observational cohorts examining various fibrinolytic assessment methods. Results: Fibrinolytic shutdown, primarily mediated by the overproduction of plasminogen activator inhibitor-1 (PAI-1), occurs early in sepsis and correlates with disease severity and mortality. Current assessment methods include plasma biomarker measurements (PAI-1, plasmin-antiplasmin complexes, D-dimer), global plasma-based tests (clot lysis time, plasmin generation assays), and whole-blood viscoelastic testing (rotational thromboelastometry, ROTEM; thromboelastography, TEG). Modified viscoelastic tests incorporating tissue plasminogen activators demonstrate enhanced sensitivity for detecting fibrinolytic resistance. Despite efforts, standardization is still limited, and routine clinical implementation has not been achieved yet. Conclusions: Fibrinolytic assessment provides important prognostic information in sepsis, despite methodological challenges. The integration of point-of-care viscoelastic testing with modified protocols shows promise for real-time evaluation. Future research should focus on developing standardized, automated assays suitable for routine clinical practice, enabling personalized therapeutic interventions that target fibrinolytic dysfunction in sepsis. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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Other

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20 pages, 4719 KB

Open AccessSystematic Review

Levosimendan vs. Dobutamine in Patients with Septic Shock: A Systematic Review and Meta-Analysis with Trial Sequential Analysis

by Edith Elianna Rodríguez, German Alberto Devia Jaramillo, Lissa María Rivera Cuellar, Santiago Eduardo Pérez Herran, David René Rodríguez Lima and Antoine Herpain

J. Clin. Med. 2025, 14(15), 5496; https://doi.org/10.3390/jcm14155496 - 5 Aug 2025

Cited by 1 | Viewed by 4327

Abstract

Introduction: Septic-induced cardiomyopathy (SICM) is a life-threatening condition in patients with septic shock. Persistent hypoperfusion despite adequate volume status and vasopressor use is associated with poor outcomes and is currently managed with inotropes. However, the superiority of available inotropic agents remains unclear. This [...] Read more.

Introduction: Septic-induced cardiomyopathy (SICM) is a life-threatening condition in patients with septic shock. Persistent hypoperfusion despite adequate volume status and vasopressor use is associated with poor outcomes and is currently managed with inotropes. However, the superiority of available inotropic agents remains unclear. This meta-analysis aims to determine which inotropic agent may be more effective in this clinical scenario. Methods: A systematic review and meta-analysis were conducted, including data from randomized clinical trials (RCTs) comparing levosimendan and dobutamine in patients with septic shock and persistent hypoperfusion. Summary effect estimates, including odds ratios (ORs), standardized mean differences (SMDs), and 95% confidence intervals (CIs), were calculated using a random-effects model. Trial sequential analysis (TSA) was also performed. Results: Of 244 studies screened, 11 RCTs were included. Levosimendan was associated with a reduction in in-hospital mortality (OR 0.64; 95% CI: 0.47; 0.88) and ICU length of stay (SMD 5.87; 95% CI: –8.37; 20.11) compared with dobutamine. Treatment with levosimendan also resulted in significant reductions in BNP (SMD –1.87; 95% CI: –2.45; −1.2) and serum lactate levels (SMD –1.63; 95% CI: –3.13; −0.12). However, TSA indicated that the current evidence is insufficient to definitively confirm or exclude effects on in-hospital and 28-day mortality. Conclusions: Levosimendan may improve hemodynamics, tissue perfusion, and biomarkers, and may reduce in-hospital mortality and ICU length of stay in patients with SICM compared with dobutamine. However, TSA highlights the need for further studies to inform clinical practice and optimize inotrope selection. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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14 pages, 2291 KB

Open AccessSystematic Review

Hemoadsorption in the Management of Septic Shock: A Systematic Review and Meta-Analysis

by David Steindl, Tim Schroeder, Alexander Krannich and Jens Nee

J. Clin. Med. 2025, 14(7), 2285; https://doi.org/10.3390/jcm14072285 - 27 Mar 2025

Cited by 20 | Viewed by 5793

Abstract

Background/Objectives: Septic shock remains a significant clinical challenge with consistently high mortality rates. Recent investigations have focused on the efficacy of CytoSorb^® (CytoSorbents Corporation, Monmouth Junction, NJ, USA), an extracorporeal cytokine adsorber, and how it impacts outcomes in sepsis. The current [...] Read more.

Background/Objectives: Septic shock remains a significant clinical challenge with consistently high mortality rates. Recent investigations have focused on the efficacy of CytoSorb^® (CytoSorbents Corporation, Monmouth Junction, NJ, USA), an extracorporeal cytokine adsorber, and how it impacts outcomes in sepsis. The current meta-analysis reports on the impact of CytoSorb^® on survival, specifically in septic shock patients. Methods: We conducted a comprehensive systematic search across the PubMed and COCHRANE databases for studies published up to 10 June 2024. The analysis prioritized randomized controlled trials and observational studies with control groups involving septic shock patients while excluding case reports and case series. Nine studies were finally included in our meta-analysis following the initial screening of 115 articles after excluding duplicates and irrelevant entries. Results: The meta-analysis was performed on 744 critically ill patients with septic shock from one RCT and eight observational studies. Of these, 449 patients received treatment with CytoSorb^® in addition to standard care. Our data indicate that CytoSorb^® use is associated with reduced in-hospital mortality, evidenced by an odds ratio (OR) of 0.64 [0.42; 0.97] and a p-value of 0.036. For 28–30-day mortality, the findings were more pronounced with an OR of 0.46 [0.28; 0.78] and a p-value of 0.003. The analysis of the longest observed mortality showed a trend for improved survival within the CytoSorb group; however, it did not reach statistical significance. Additionally, there was a significant improvement in hemodynamic stability as a secondary endpoint, as evidenced by notable reductions in vasopressor requirements in the hemoadsorption group. Conclusions: The current meta-analysis suggests that the use of CytoSorb^® alongside standard of care management may be linked to improved short-term survival in patients with septic shock; however, these findings should be interpreted with caution in light of the heterogeneity and the modest quality of the studies included. Prospective studies are needed to better determine the impact of hemoadsorption on shock reversal and survival in these critically ill patients. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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