Effects on mortality of different blood purification techniques in sepsis patients: an umbrella review of systematic reviews and meta-analyses

Clinical Snapshot

Key Findings

• P Value: Not reported in available abstract data

• Effect Size: Mortality estimates generally favoured EBP over conventional care; polymyxin B hemoperfusion showed the most consistent directional signal toward lower mortality; RRT-based strategies showed effects closer to the null. Specific pooled effect sizes not reported in available abstract data.

• Primary Outcome: All-cause mortality in sepsis patients treated with extracorporeal blood purification versus conventional care

• Nnt Or Sensitivity: Not calculable from available data; no NNT, absolute risk reduction, or number needed to treat reported. Given low certainty of evidence and absence of precise effect estimates, NNT derivation would be unreliable.

• Confidence Interval: Not reported in available abstract data

Clinical Application

EBP modalities vary substantially in feasibility, cost, and availability. CRRT is widely available in Australian tertiary ICUs. Polymyxin B hemoperfusion (Toraymyxin) has limited availability in Australia and is not PBS-listed. High-volume haemofiltration and coupled plasma filtration adsorption require specialised equipment and expertise. Implementation of any modality based on current evidence is premature given low certainty of mortality benefit. In Australia, CRRT is standard of care for acute kidney injury in septic patients and is supported by RACGP and CICM (College of Intensive Care Medicine) guidelines. Polymyxin B hemoperfusion is not TGA-approved for routine use in Australia and is not listed on the PBS. The EUPHRATES trial (which showed no mortality benefit of polymyxin B hemoperfusion in unselected septic shock patients) is relevant context. Australian intensivists should note that this umbrella review does not provide sufficient evidence to justify adoption of novel EBP modalities outside of clinical trial settings. The ANZICS Clinical Trials Group framework would be the appropriate vehicle for evaluating EBP modalities in the Australian context. Cost-effectiveness analyses relevant to the Australian healthcare system are absent from this review. Critically ill adult patients with sepsis or septic shock in ICU settings where extracorporeal blood purification modalities are available. Findings are most directly applicable to patients with endotoxaemia or gram-negative sepsis where polymyxin B hemoperfusion has shown the most consistent directional signal.

Abstract

Sepsis remains a leading cause of mortality worldwide, and extracorporeal blood purification has been widely implemented despite ongoing uncertainty regarding its survival benefit. We conducted an umbrella review of 42 systematic reviews and meta-analyses evaluating mortality across major extracorporeal blood purification modalities. Mortality estimates generally favored extracorporeal blood purification over conventional care, but effect sizes and consistency varied substantially by modality, and the overall certainty of evidence for mortality was low. At the review level, polymyxin B hemoperfusion showed a relatively consistent direction toward lower mortality, whereas renal replacement therapy-based strategies were typically closer to the null. However, most included reviews were of low or critically low methodological quality, with downgrading driven by risk of bias, inconsistency, and potential publication bias. Therefore, these findings should be interpreted cautiously and should not be considered definitive evidence of survival benefit. They highlight persistent evidentiary fragility and underscore the need for rigorously designed, phenotype-informed trials to clarify modality-specific effects in sepsis. What is known: Extracorporeal blood purification has been widely used as an adjunctive therapy for sepsis, but its mortality benefit remains uncertain across different modalities.What this study adds: This umbrella review synthesizes evidence from 42 systematic reviews and meta-analyses and shows that mortality estimates generally favor extracorporeal blood purification, although effects vary substantially by modality and the overall certainty of evidence remains low.Potential impact: These findings support cautious, modality- and phenotype-informed interpretation of extracorporeal blood purification in sepsis and highlight the need for rigorously designed trials with standardized protocols.

References

1. 1.Yuan, Y., Lei, S., Duan, A., & Li, J. (2026). Effects on mortality of different blood purification techniques in sepsis patients: an umbrella review of systematic reviews and meta-analyses. Renal Failure. https://doi.org/10.1080/0886022X.2026.2698155