| Objective:To assess the effect and prognosis of continuous blood purification in patients with sepsis.Methods:We systematically reviewed clinical research about continuous blood purification therapy for sepsis in multiple data-base from January 1990 to February 2014(Pub Med, ISI WOK, Science Online, Nature, Sino MED,Wanfang Data, CNKI, and CQVIP);English keywords “systematic review, continuous blood purification, sepsis, survival rate, and MODS†were included. After screening and assessing the quality of the data, we including research with the inclusion criteria.The inclusion criteria:(1) Randomized controlled trials or prospective cohort studies were selected.(2) The diagnosis of sepsis should be consistent with the criteria of 2001 ACCP / SC.CM.(3) Intervention: In CBP group, CBP should be given in the 24 h after ICU admission, with the duration ranging from 24 h to 72 h. In control group, conventional treatment(anti-infection treatment and organ support therapy including respiratory system, circulatory system, urinary system, immunity system, digestive system and other systems) were given.(4) Observation indexes:①The numbers of survival cases 28 days.②Duration of mechanical ventilation.③APACHEⅡ scores after therapy.④Length of ICU stay.⑤The numbers of MODS cases. The exclusion criteria:(1) Retrospective study or case report.(2) Animal experiment.(3) Duplication, study with incomplete data. Two independent authors assessed the quality of the data with Modified jadad score: randomized or not; randomization was described or not; the method of randomization was appropriate or not; allocation concealment was described or not; the method of allocation concealment was appropriate or not; double blinding or not; double blinding was described or not; the method of double blinding was appropriate or not; withdrawals and dropouts was described or not. If there were differences, two authors got conclusion after discussion; Two authors independently extracted study data which, include: authors, published date, journal name, basic disease, sex ratio, the numbers of survival cases in 28 days, duration of mechanical ventilation, APACHEⅡ scores after therapy, length of ICU stay, the numbers of MODS cases; Rev Man 5.1.1 software were used for data analysis. Continuousvariables data were represented with mean difference(MD), 95% confidence interval(CI); Eenumeration data were represented with odds ratio(OR), 95% confidence interval(CI); Heterogeneity testing of the results: there were no significant heterogeneity, and the fixed effect model was used when I2<50%, while there were marked heterogeneity and the random effects model was used when I2>50%.Then we analyzed the existence of publication bias with the funnel plot. If the funnel plot was asymmetrical, we believed publication bias was exist.Results:Ten studies which included with 541 septic patients.(272 patients in CBP group and 269 patients in control group)were analyzed. The Meta analysis results showed that,comparing with control group, the number of survival cases in 28 days of CBP group was higher[OR=2.12, 95%CI(1.47,3.05),Z=4.05(P<0.0001)], The number of MODS cases of CBP group was lower[OR=0.42, 95%CI(0.21,0.81),Z=2.56(P=0.01)], Length of ICU stay(days) [MD=-3.08, 95%CI(-3.95,-2.21),Z=6.92(P<0.00001)] and duration of mechanical ventilation(days) [MD=-2.76, 95%CI(-3.37,-2.14),Z=8.80(P<0.0001)]in CBP group were shorter. After therapy, patients in CBP group also showed lower APACHEⅡ scores compared with control group[MD=-3.60, 95%CI(-5.22,-1.98),Z=4.36(P<0.0001)].Conclusion: CBP combined therapy is superior to conventional therapy in the management of sepsis. |
