The Efficacy of Hemoperfusion in Severe COVID-19 Patients: A Systematic Review and Meta-Analysis

INTRODUCTION: This study aimed to conduct a meta-analysis and systematic review to assess the efficacy of hemoperfusion (HP) in patients with severe coronavirus disease 2019 (COVID-19). METHODS: A comprehensive search for candidate publications was performed using PubMed, Cochrane Library, and Embase. Studies investigating the effect of HP on mortality among severe COVID-19 patients were selected, including randomized controlled trials (RCTs), non-RCTs, and observational studies with control groups. The primary endpoint was the longest reported mortality, while the secondary endpoints were the length of stay, intensive care unit (ICU) stay, P/F ratio, and C-reactive protein (CRP). The Cochrane test (Q) and I2 test were used to quantify heterogeneity among the studies. The fixed-effect model (Mantel-Haenszel method) would be selected when there is no heterogeneity (p > 0.10 and I2 <50%), whereas the random-effect model (DerSimonian-Laird method) was used in obvious heterogeneity (p ≤ 0.10 and I2 ≥50%). Data are presented as risk ratio (RR), 95% confidence intervals (CIs), p values, and I2. RESULTS: Of the 127 articles retrieved, 14 were selected for this study, including 405 patients in the HP group and 518 patients in the control group. There was no statistically significant difference in mortality between the HP and the control groups (RR 0.81 95% CI: [0.71, 0.93]; p = 0.15 > 0.05; I2 = 68.2%). The results of the subgroup analysis of HP with HA series indicated a reduction in the mortality of patients with COVID-19 (RR 0.60 [0.46, 0.78]; p < 0.0001; I2 = 0.0%). The HP group had a longer hospital stay compared with the control group (weighted mean difference; WMD 5.25 [2.53, 7.97] days; p < 0.05; I2 = 28.0%), but not the ICU stay (ES 1.33 [-2.86, 5.53] days; p = 0.53; I2 = 85.5%). After HP, the P/F ratio (WMD 95.79 [74.46, 117.12] mm Hg; p < 0.05; I2 = 5.8%) increased, while CRP (WMD -44.03 [-68.97, -19.09] mg/L; p < 0.05; I2 = 86.9%) decreased. CONCLUSION: This study found that HP did not significantly reduce mortality in COVID-19 patients; however, the HA series showed potential mortality benefits, suggesting its clinical applicability. While the HP group had longer hospital stays, ICU stay durations did not differ significantly. Notably, HP improved the P/F ratio and reduced CRP levels post-treatment.