Presentation (CTI)

OBJECTIVES: Septic shock is characterised by elevated inflammatory responses that can lead to organ dysfunction, multiorgan failure, and high mortality despite standard care. Blood purification therapies are designed to remove circulating endotoxins and/or inflammatory mediators; however, the supporting evidence base has not been comprehensively assessed. This study characterised the clinical and economic evidence landscape for blood purification therapies in septic shock by mapping study populations, key outcomes, and consolidated findings across published literature.
METHODS: A targeted literature review (TLR) was conducted to map the breadth of evidence relating to extracorporeal blood purification therapies, defined as therapies using an external circuit to remove/modulate circulating substances, including plasma exchange, adsorption-based and renal replacement therapies in septic shock. Specific and broader search terms were used in database searches (MEDLINE and Embase) to identify publications from 1995 onwards, supplemented by targeted desk research addressing evidence gaps. Evidence was screened by a single reviewer with 20% quality assurance conducted by a second reviewer.
RESULTS: The identified evidence base comprised observational studies, comparative studies, systematic reviews, and meta-analyses across multiple geographies. Studies primarily evaluated patients with septic shock, including subpopulations (sepsis-associated acute kidney injury and multiple organ dysfunction) to capture the spectrum of disease severity. Where studies reported broader sepsis populations, septic shock-specific data were extracted. Evidence suggested improvements in inflammatory burden, organ function, and haemodynamic stability with blood purification therapies in patients with septic shock. However, evidence was predominantly observational, with limited comparative evidence. While short-term clinical outcomes were well represented, long-term outcomes were less frequently reported, and economic evidence remained a key gap.
CONCLUSIONS: The TLR identified a heterogeneous evidence landscape for blood purification in septic shock, particularly for mechanistic rationale and short-term outcomes. However, gaps remain, including limited comparative effectiveness, long-term outcomes, and economic evidence. These findings may help prioritise evidence generation and decision-making in critical care.