Coupled plasma haemofiltration filtration in severe XXXX : systematic review and meta-analysis.

@entity1 @entity26 @entity295 @entity8085
INTRODUCTION: Coupled plasma filtration and adsorption (CPFA) has been used in the treatment of severe @entity295 with the intention of removing the proinflammatory and anti-inflammatory mediators from the systemic circulation. It is believed that this interrupts and moderates the septic cascade, but there is uncertainty about the benefits of this therapy. METHODS: A systematic review and meta-analysis were performed to estimate the effects of CPFA on mortality in severe @entity295 . The Cochrane CENTRAL Register of Controlled Trials, CINAHL, EMBASE, MEDLINE-EBSCO-Host, MEDLINE and ProQuest, were searched from 1997 to 2013. Randomised controlled trials, prospective cohort studies and retrospective cohort studies were included using the Centre for Reviews and Dissemination (CRD) framework. Data were abstracted using standard pro forma, and studies independently reviewed by two authors to confirm inclusion criteria. Quality of studies and risk of bias were assessed using the Grading of Recommendations, Assessment, Development and Evaluation Working Group (GRADE) and Critical Appraisal Skills ( @entity8085 ) criteria, respectively. Meta-analysis was performed using Review Manager (RevMan V.5.1) software. The primary outcome was 28-day mortality. Secondary outcomes were mediator adsorption (picograms/mL), mean arterial BP (mm   Hg) and oxygenation ratio. RESULTS: 17 studies met the inclusion criteria (n=441 @entity1 , 242 CPFA). 14 studies reported the primary outcome of 28-day mortality. There were 88 deaths in CPFA @entity1 versus 118 in those receiving haemofiltration: OR 0.34 (95% CI 0.24 to 0.13). Point estimates of effect on the secondary outcomes of mean arterial pressure and @entity26 ratio favoured CPFA. Studies were small and heterogenous. CONCLUSIONS: Evidence for CPFA in severe @entity295 is sparse, of poor quality and further research is required, however, this meta-analysis noted improvements in survival rates of those @entity1 treated with CPFA.
