The effect of extracorporeal blood purification therapies on mortality in the treatment of septic shock in the intensive care unit

Abstract

Introduction:

Sepsis is a life-threatening condition characterized by organ dysfunction due to a dysregulated host response to infection. Septic shock, a severe form of sepsis, involves hypotension requiring vasopressor support and elevated lactate levels, leading to tissue hypoperfusion. Beyond standard therapy, various extracorporeal blood purification techniques have been developed to remove infectious agents and inflammatory mediators produced by the dysregulated immune response.

Materials and methods:

This multicenter, retrospective observational cohort study analyzed medical records of patients hospitalized between 2021 and 2024. Patients with comparable admission timing and baseline SOFA and APACHE II scores were divided into two groups: Group 1 (no adsorptive therapy) and Group 2 (adsorptive therapy). Baseline and follow-up SOFA scores, vital signs, laboratory parameters, and culture results on days 1, 3, 5, and 10 were recorded.

Results:

The overall mortality rate was 73.5% (275 ex). Crude mortality was 74.3% (139/187) in the no-filter group and 72.7% (136/187) in the filter group, with no significant difference observed (p = 0.815). Across all analytical approaches, no analysis reached statistical significance at the 0.05 level, with p-values ranging from 0.081 to 0.815. CRP, procalcitonin, and lactate levels showed a decreasing trend in both groups during treatment, with no significant differences between groups (p = 0.168, 0.322, and 0.649). Mortality did not differ significantly between early (within first 24 h) and late (>24 h) filter application groups (HR p = 0.91, p = 0.62).

Conclusion:

In patients with septic shock, filters used for extracorporeal blood purification reduce the levels of inflammatory mediators. However, no effect on mortality reduction was observed.