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Coupled plasma haemofiltration filtration in severe sepsis: systematic review and meta-analysis
  1. Ian Hazzard1,2,
  2. S Jones3 and
  3. T Quinn4
  1. 1Ministry of Defence Hospital Unit, Friarage Hospital, South Tees Hospitals NHS Trust, Northallerton, UK
  2. 2Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, UK
  3. 3Department of Population Health, New York University Medical School, New York, NY, US
  4. 4Faculty of Health, Social Care and Education, St George's, University of London & Kingston University, London, UK
  1. Correspondence to Major Ian Hazzard MDHU Northallerton, James Cook University Hospital, Middlesbrough TS4 3BW, UK; ianhazzard{at}hotmail.com

Abstract

Introduction Coupled plasma filtration and adsorption (CPFA) has been used in the treatment of severe sepsis with the intention of removing the proinflammatory and anti-inflammatory mediators from the systemic circulation. It is believed that this interrupts and moderates the septic cascade, but there is uncertainty about the benefits of this therapy.

Methods A systematic review and meta-analysis were performed to estimate the effects of CPFA on mortality in severe sepsis. The Cochrane CENTRAL Register of Controlled Trials, CINAHL, EMBASE, MEDLINE—EBSCO–Host, MEDLINE and ProQuest, were searched from 1997 to 2013. Randomised controlled trials, prospective cohort studies and retrospective cohort studies were included using the Centre for Reviews and Dissemination (CRD) framework. Data were abstracted using standard pro forma, and studies independently reviewed by two authors to confirm inclusion criteria. Quality of studies and risk of bias were assessed using the Grading of Recommendations, Assessment, Development and Evaluation Working Group (GRADE) and Critical Appraisal Skills (CASP) criteria, respectively. Meta-analysis was performed using Review Manager (RevMan V.5.1) software. The primary outcome was 28-day mortality. Secondary outcomes were mediator adsorption (picograms/mL), mean arterial BP (mm Hg) and oxygenation ratio.

Results 17 studies met the inclusion criteria (n=441 patients, 242 CPFA). 14 studies reported the primary outcome of 28-day mortality. There were 88 deaths in CPFA patients versus 118 in those receiving haemofiltration: OR 0.34 (95% CI 0.24 to 0.13). Point estimates of effect on the secondary outcomes of mean arterial pressure and oxygen ratio favoured CPFA. Studies were small and heterogenous.

Conclusions Evidence for CPFA in severe sepsis is sparse, of poor quality and further research is required, however, this meta-analysis noted improvements in survival rates of those patients treated with CPFA.

  • Sepsis
  • Coupled Plasma Filtration Adsorption
  • Received September 29, 2015.
  • Revision received October 5, 2015.
  • Accepted October 10, 2015.

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  • Received September 29, 2015.
  • Revision received October 5, 2015.
  • Accepted October 10, 2015.
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