[Effects of high volume hemofiltration on mortality in patients with septic shock: a meta-analysis].

OBJECTIVE To evaluate the effect of high volume hemofiltration (HVHF) and its therapeutic timing on mortality in patients with septic shock. METHODS Randomized controlled trials (RCT), case-control studies and prospective cohort studies on HVHF treating septic shock patients from 1999 to 2009 were identified by electronic and manually retrieving related data. An Meta-analysis of HVHF on mortality in septic shock patients was conducted through the methods recommended by the Cochrane Collaboration. RESULTS 3 RCTs, 1 case-control study and 5 prospective cohort studies were selected. A total of 167 cases in 4 studies (3 RCTs, 1 case-control study) involving 79 HVHF and 88 LVHF groups were included for a Meta-analysis. The mortalities of septic shock in HVHF and LVHF groups were 40.5% (32/79) and 72.7% (64/88) respectively. As compared with traditional LVHF, HVHF could reduce the mortality in patients with septic shock [OR 0.33, (95%CI, 0.17 - 0.64); P < 0.01]. For 170 patients with septic shock in 5 prospective cohort studies, their mortality rates were improved by HVHF [OR 0.31, (95%CI, 0.19 - 0.49); P < 0.01]. It was consistent with the results of 4 control studies. Only 2 studies indicated the early HVHF group versus the late HVHF group could improve the survival of septic shock. Since there was significant heterogeneity between them (P < 0.05), it was better not to perform a Meta-analysis. CONCLUSION There is a beneficial effect of high volume hemofiltration on mortality in septic shock patients. Further studies of a larger sample of high quality RCTs should be carried out to guide its use.