The therapeutic effect of high-volume hemofiltration on sepsis: a systematic review and meta-analysis

Background: Sepsis remains the leading cause of death in the intensive care unit (ICU), despite the treatment of sepsis has progressed. As a mode in continuous renal replacement therapy (CRRT), continuous veno-venous hemofiltration (CVVH) has been widely used in the treatment of sepsis. Whether high ultrafiltrate volume in CVVH is beneficial for sepsis survival remains controversial. We performed a systematic review and meta-analysis to evaluate the treatment effect of high-volume hemofiltration (HVHF) on sepsis.

Methods: A systematic search was conducted on the Medline, Embase, and Cochrane library to June 21, 2019, the keywords included "sepsis" "continuous blood purification" "continuous renal replacement therapy" "continuous veno-venous hemofiltration" and "continuous veno-venous hemodiafiltration". Summery statistic in this review was risk ratio (RR) and was performed by RevMan 5.2.

Results: Five randomized controlled trials (RCT) were included which contained 241 participants. Mortality related endpoints and other observations (length of stay, organ function evaluation, effect on hemodynamics, cytokine clearance and respiratory function) were used to assess the treatment effect of HVHF in sepsis. Three trials reported 28-day mortality, one of three trails also reported 60- and 90-day mortality; one trail did not specify the type of mortality; the fifth article reported hospital mortality. The pooled risk ratio for three trails of 28-day mortality was 0.96 (0.67, 1.38). Three trails reported length of stay related data. Four trails reported organ failure related scores. All trails reported the effect of HVHF on hemodynamics. Three trails reported cytokine clearance. Only two trails reported respiratory function related indicators. After analysis, the risk of bias in all trails was low.

Conclusions: The meta-analysis results suggested that treatment programs contained HVHF did not change the outcomes of patients with sepsis. So far, related studies on the use of HVHF in critically ill patients with sepsis or septic shock is rare. Researchers should consider additional large multicenter randomized controlled trials.