Septic shock remains one of the leading causes of death in intensive care units worldwide, especially among patients who develop acute kidney injury and need continuous renal replacement therapy (CRRT). Despite advances in modern critical care, mortality rates are still alarmingly high, particularly in low-resource settings. To improve outcomes, clinicians increasingly use extracorporeal blood purification techniques, therapies designed to remove inflammatory mediators from the bloodstream and potentially restore immune balance during severe infections. However, it remains unclear whether different blood purification strategies provide meaningful clinical advantages.
A new study conducted at a tertiary intensive care unit in Bosnia and Herzegovina offers valuable real-world insights into this issue. The research compared two common approaches: CytoSorb Ⓡ , a hemoadsorption cartridge added to standard CRRT, and oXiris Ⓡ , a specialized membrane that combines kidney support with the removal of inflammatory mediators. The study involved 97 adult patients with septic shock treated between 2023 and 2024. Researchers assessed whether the type of blood purification strategy affected recovery from shock, measured by the number of days patients remained alive without vasopressor support within the first 28 days. This study led by Professor Pedja Kovacevic and Professor Jihad Mallat was published online on February 19, 2026 in the Journal of Intensive Medicine
Both treatments showed clear improvements in patients’ hemodynamic status. In both groups, lactate levels decreased, vasopressor requirements decreased, and blood pressure improved after therapy. These findings suggest that extracorporeal blood purification may help stabilize critically ill patients in the short term. However, when directly compared, no significant differences were found in the primary outcome. Patients treated with CytoSorb Ⓡ and those treated with oXiris Ⓡ experienced similar numbers of vasopressor-free days. There were also no meaningful differences in secondary outcomes, including duration of mechanical ventilation, length of ICU stay, or survival rates.
“ These findings suggest that both approaches may offer comparable clinical benefits in septic shock, at least in terms of short-term hemodynamic recovery ,” the authors note. Importantly, the study highlights how complex treating sepsis can be. While both devices can remove inflammatory mediators like cytokines and endotoxins, ongoing production and redistribution of these molecules in the body may limit their overall clinical impact. This might explain why improvements in physiological parameters do not always lead to better survival outcomes. The authors also point out that differences in initial severity between patient groups could have influenced the results. Patients treated with CytoSorb Ⓡ had higher initial inflammation levels, which may partly explain the lack of clear differences between the two strategies.
Although these findings offer valuable comparative data, the researchers warn that the study has several limitations. As a single-center retrospective analysis, it could be affected by selection bias and unmeasured confounding factors. Additionally, the relatively small sample size limits the ability to detect subtle but clinically meaningful differences. Despite these limitations, this study is among the first direct comparisons of two major extracorporeal blood purification strategies used in septic shock. The results suggest that, in real-world clinical practice, both approaches may lead to similar outcomes when used with CRRT.
The authors conclude that larger, prospective, multicenter randomized trials are urgently needed to identify which patients may benefit most from extracorporeal blood purification and to determine the best timing and selection of therapy. As research continues to develop personalized approaches to sepsis treatment, understanding how to effectively use advanced extracorporeal therapies could be crucial for improving outcomes in this critically ill population.
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Reference
DOI: 10.1016/j.jointm.2025.12.010
Prof. Pedja Kovacevic, MD, PhD, FCCP, FCCM, from the University of Banja Luka, Bosnia and Herzegovina
Prof. Pedja Kovacevic is Head of the Medical Intensive Care Unit at the University Clinical Centre of the Republic of Srpska and Professor of Medicine at the University of Banja Luka, Bosnia and Herzegovina, and the University of Belgrade, Serbia. He is a national coordinator for intensive care medicine and a leader in developing critical care systems in low-resource settings. His work focuses on education, tele-ICU, and implementation research, with over 60 peer-reviewed publications.
Prof. Jihad Mallat, MD, PhD, FCCM, from the University of Banja Luka, Bosnia and Herzegovina
Prof. Jihad Mallat is a Staff Physician and Section Head of Medical/Surgical Critical Care at Cleveland Clinic Abu Dhabi, UAE. He is also Professor of Medicine at Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, USA, and Medical Faculty of the University of Banja Luka, Bosnia and Herzegovina. Board-certified in Anesthesiology and Intensive Care Medicine, he has published over 150 peer-reviewed articles and holds a PhD in Clinical Research, with expertise in critical care and clinical methodology.
Journal of Intensive Medicine
Observational study
People
Impact of different extracorporeal blood purification strategies during continuous renal replacement therapy in septic shock patients
19-Feb-2026
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.