title: Blood purification and mortality in sepsis: a meta-analysis of randomized trials.
abstract: OBJECTIVE
  Although blood purification improves outcomes in animal studies of sepsis, results of clinical trials have been mixed. We conducted a systematic review and meta-analysis of randomized trials to determine the association between various blood purification techniques and all-cause mortality in humans with sepsis.
  
  
  METHODS
  We searched for relevant studies in MEDLINE, EMBASE, and the Cochrane Library database from January 1966 to May 2012.
  
  
  METHODS
  Inclusion required a diagnosis of sepsis and comparison of blood purification techniques including hemofiltration, hemoperfusion, plasma exchange, or hemodialysis with no blood purification (control group).
  
  
  METHODS
  Two authors independently selected studies and extracted data. Summary statistics, risk ratios, and CIs were calculated using random-effects modeling. Study quality was assessed using Jadad score, and publication bias was assessed using funnel plots and Egger's statistic.
  
  
  RESULTS
  Overall, blood purification decreased mortality compared with no blood purification (35.7% vs 50.1%; risk ratio, 0.69 [95% CI, 0.56-0.84]; p<0.001; 16 trials, n=827). However, these results were driven mainly by hemoperfusion (risk ratio, 0.63 [95% CI, 0.50-0.80]; p<0.001; 10 trials, n=557) and plasma exchange (risk ratio, 0.63 [95% CI, 0.42-0.96]; p=0.03; two trials, n=128). Pooling of all trials of blood purification for treatment of sepsis was no longer associated with lower mortality (risk ratio, 0.89 [95% CI, 0.71-1.13]; p=0.36; eight trials, n=457) after excluding trials using polymyxin B hemoperfusion.
  
  
  CONCLUSIONS
  Blood purification techniques including hemoperfusion, plasma exchange, and hemofiltration with hemoperfusion were associated with lower mortality in patients with sepsis. These results were mainly influenced by studies using polymyxin B hemoperfusion from Japan.
authors.affiliation: Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Feihu
authors.initials: F
authors.lastname: Zhou
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Peng
authors.forename: Raghavan
authors.initials: R
authors.lastname: Murugan
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
mesh_terms: D002423:Cause of Death; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000097:blood* / Q000401:mortality*; D016060:Sorption Detoxification / Q000009:adverse effects / Q000379:methods*