The Effects of CytoSorb in Critically Ill Adult Patients on Vasopressor Support: A Systematic Review and Meta-Analysis

Background: The impact of CytoSorb hemoadsorption on hemodynamic stability, mortality, and intensive care unit length of stay in critically ill adult patients requiring vasopressor support is unclear. Methods: Systematic review and meta-analysis of randomized controlled trials and observational studies, enrolling adult intensive care unit patients requiring vasopressor support. We compared CytoSorb hemoadsorption versus standard care or control interventions. Results: Twelve studies enrolling 568 patients met the inclusion criteria. Primary outcomes included noradrenaline dosage, mortality at longest follow-up, and intensive care unit length of stay. CytoSorb treatment significantly reduced noradrenaline requirements (mean difference −0.08 μg/kg/min [95% CI: −0.15 to −0.02], p = 0.02, I2 = 8%). Mortality at the longest follow-up was lower with CytoSorb (risk ratio 0.66 [95% CI: 0.55–0.80], p < 0.001, I2 = 0%), though this finding was driven primarily by observational studies; randomized controlled trials alone showed non-significant mortality reduction (risk ratio 0.23 [95% CI: 0.05–1.06], p = 0.06). No difference in intensive care unit length of stay was observed (mean difference 0.24 days [95% CI: −1.23 to 1.70], p = 0.75). Trial sequential analysis indicated insufficient information size for definitive conclusions. Overall evidence quality was low to very low. Conclusions: CytoSorb hemoadsorption may reduce vasopressor requirements in critically ill patients. Observed mortality benefits were driven primarily by observational studies, with RCTs showing non-significant trends. Overall evidence quality is low, and findings should be considered hypothesis-generating; adequately powered RCTs are needed before clinical recommendations can be made.