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Impact of different extracorporeal blood purification strategies during continuous renal replacement therapy in septic shock patients

Year: 2026

Type: article

Abstract: Septic shock with acute kidney injury is associated with high mortality. Hemoadsorption methods such as CytoSorb Ⓡ in conjunction with standard continuous renal replacement therapy (CRRT) and oXiris Ⓡ -based CRRT are increasingly used; however, comparative data are scarce. This study assessed the effects of both filters on vasopressor-free days and key clinical outcomes in septic shock. This retrospective single-center cohort included adults with septic shock treated with CytoSorb Ⓡ in conjunction with CRRT or oXiris Ⓡ -based CRRT between January 2023 and December 2024. The primary endpoint was vasopressor-free days to day 28, with secondary outcomes including Sequential Organ Failure Assessment (SOFA) score, lactate levels, norepinephrine equivalent dose (NEED), mean arterial pressure, ventilator-free days, intensive care unit (ICU) length of stay, and mortality. A total of 97 patients were included in the analysis. (CytoSorb Ⓡ n =75; oXiris Ⓡ n =22). Both extracorporeal blood purification modalities were associated with comparable reductions in lactate levels (median [IQR]: −39.7 [−47.2 to −19.3]% vs. 44.5 [−54.0 to −33.3] %, respectively, P =0.14), and NEED (median [IQR]: −36.1 [−66.7 to −9.1] vs. −56.4 [−83.3 to −12.5] %, respectively, P =0.36), along with similar increases in mean arterial pressure (9.6 [7.7–18.2]% vs. 9.8 [7.7–16.7] %, respectively, P =0.94). No significant differences were found between the two modalities. Vasopressor-free days were similar (median [IQR]: 0.0 [0–24] days with CytoSorb Ⓡ vs. 20.5 [0–25] days with oXiris Ⓡ , P =0.55). In the multivariable competing-risks analysis, extracorporeal blood purification modality was not independently associated with vasopressor-free days after adjustment for potential confounders (subhazard ratio [sHR]=0.97, 95% confidence interval: 0.48–1.94, P =0.93). Ventilator-free days, ICU stay, and ICU and hospital mortality were likewise comparable. CytoSorb Ⓡ in addition with CRRT and oXiris Ⓡ -based CRRT demonstrated similar hemodynamic and clinical outcomes. Larger prospective studies are needed to define the optimal role of extracorporeal CRRT-based blood purification in septic shock.

Source: Journal of Intensive Medicine

DOI: 10.1016/j.jointm.2025.12.010