Network meta-analysis finds PMX and HA 330 blood purification may reduce mortality in severe septic shock

BACKGROUND: Sepsis is a very severe condition that carries a high risk of death. Blood purification methods have been employed alongside conventional treatment to help decrease the death rate associated with severe sepsis. RESEARCH QUESTION: The objective of our network meta-analysis (NMA) was to determine the most efficient blood purification device for decreasing mortality in individuals with severe septic shock. STUDY DESIGN AND METHODS: The network meta-analysis (NMA), which incorporated randomized clinical trials (RCTs), was performed by modeling the binary outcome "mortality" utilizing a Bayesian hierarchical model. We examined direct comparisons of blood purification methods employed for the immediate management of individuals experiencing severe septic shock. The studies' risk of bias was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions. The main result was death rate. We calculated summary relative risks (RRs) through pairwise meta-analysis and NMA employing fixed effects. We utilized the surface beneath the cumulative ranking curve (SUCRA) to display the order of interventions. RESULTS: Out of 379 references, we incorporated 31 RCTs. We discovered 15 distinct treatment approaches. The overall count of patients was 2678. The forest plot, league heat table, and SUCRA plot indicated that the TORAYMYXIN™ filter (PMX) and HA 330™ were the sole devices that notably decreased mortality in comparison to standard treatment. INTERPRETATION: The PMX filter and HA 330 for blood purification greatly lower mortality rates in patients experiencing severe septic shock. All patients who received convection at any prescribed convective dose exhibited greater mortality compared to those receiving standard therapy. PROSPERO (CRD42023486159).