Effects of CytoSorb® hemoadsorption therapy on serum myoglobin and creatine kinase levels in severe rhabdomyolysis: a systematic review and meta-analysis.
17 affiliations
- 1Critical Care Unit, Royal Surrey County Hospital, Guildford, Surrey, UK.
- 2Department of Anesthesiology, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
- 3Critical Care Unit, Royal Surrey County Hospital, Guildford, Surrey, UK. [email protected].
- 4School of Medicine, Kate Granger Building, University of Surrey, Egerton Rd, Guildford, GU2 7XX, UK. [email protected].
- 5Department of Nephrology, Korea University Anam Hospital, Seoul, South Korea.
- 6Medical Clinic I - Cardiology, Pulmonology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg-Alzenau, Academic Teaching Hospital of Julius-Maximilians-University Würzburg, Am Hasenkopf 1, D-63739, Aschaffenburg, Germany.
- 7Medical Affairs, CytoSorbents Europe GmbH, Müggelseedamm 131, D- 12587, Berlin, Germany.
- 8Medical Clinic V, Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Naumburgstraße 15, D-38124, Braunschweig, Germany.
- 9Department of Anesthesiology, University Hospital Duesseldorf, Heinrich- Heine University, Moorenstr.5, D-40225, Duesseldorf, Germany.
- 10Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Saarland University Hospital, D-66424, Homburg, Germany.
- 11Division of Nephrology, University Hospital Rostock, Ernst-Heydemann-Str. 7, D-18055, Rostock, Germany.
- 122-Fraunhofer IZI Rostock, Schillingallee 68, 18057, Rostock, Germany.
- 13Department of Anesthesiology and Intensive Therapy, Semmelweis University, Üllői út 78, Budapest, H-1082, Hungary.
- 14Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 49 Przybyszewskiego St, Poznan, 60-355, Poland.
- 15Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, School of Medicine, Catholic University of Zagreb, Zagreb, Croatia.
- 16Medical Intensive Care Unit, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
- 17University Hospital Essen, University Duisburg Essen, Essen, Germany.
Abstract
Background
In patients with severe rhabdomyolysis, active myoglobin elimination employing extracorporeal hemoadsorption has been used as a potentially beneficial adjunctive measure. However, data remains scarce regarding the biochemical and clinical effects of this approach. Our aim was to summarize the currently available literature as well as examine the available data on myoglobin and creatine kinase (CK) concentrations in patients with severe rhabdomyolysis before-and-after the use of extracorporeal hemoadsorption.Methods
A systematic literature search was performed on 6th February 2025. Where data was available analyses were conducted to assess changes in plasma myoglobin and CK concentrations before-and-after CytoSorb® (CS) hemoadsorption. Non-controlled studies and case reports were analysed via a pooled data analysis comparing myoglobin and CK concentrations before-and-after CS treatment. Controlled studies were analysed via a random-effects meta-analysis to assess CS intervention effect compared to standard treatment.Results
A systematic review of literature highlighted 18 publications on the use of CS hemoadsorption in patients with rhabdomyolysis. 14 publications were included in a pooled data analysis; all reported data on myoglobin concentrations (n = 75) and 10 included measurements for CK concentration (n = 71) pre-and-post CS therapy. There was a median absolute myoglobin reduction of 6975 [IQR 1089-18,381] µg/L, resulting in a median 31.04% decrease [IQR 4.68-47.41] following CS use. CK was associated with a median absolute reduction of 380 [IQR - 2682-2720] U/L and a median 12.44% decrease [IQR: -28.08-32.89] after CS therapy. Four controlled studies were identified and included for meta-analysis, of which all included data on myoglobin concentrations (n = 107) and 3 included CK concentrations pre-and-post use of CS therapy (n = 88). CS treatment was associated with a statistically significant post-treatment myoglobin concentration that was - 5062 µg/L (95% CI: -9438 to -687; p = 0.02) lower than that observed with standard treatment. Although CK concentrations decreased in both groups, the final post-treatment CK concentration was 4703 U/L (95% CI: -171 to 9577; p = 0.06) higher in the CS group than in the standard treatment group.Conclusions
Based on current limited evidence, this study suggests that CS therapy may be associated with reductions in circulating myoglobin concentrations in patients with severe rhabdomyolysis. However, the certainty of evidence is low, the effect on CK is unclear, and it remains to be determined if biochemical reductions in CK or myoglobin translate to improved clinical outcomes.
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BibTeX
@article{reynolds2026effects,
title = {{Effects of CytoSorb® hemoadsorption therapy on serum myoglobin and creatine kinase levels in severe rhabdomyolysis: a systematic review and meta-analysis.}},
author = {A Reynolds and C Scharf and Lui G Forni and T Y Koo and S Büttner and V Humbert and J Kielstein and D Kindgen-Milles and A Meiser and S Mitzner and Z Molnar and V Premuzic and M Soledad Taborda-Küpper and L Weidhase and A Kribben},
journal = {BMC nephrology},
year = {2026},
month = oct,
doi = {10.1186/s12882-026-05371-5},
url = {https://europepmc.org/article/MED/42963778},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Effects of CytoSorb® hemoadsorption therapy on serum myoglobin and creatine kinase levels in severe rhabdomyolysis: a systematic review and meta-analysis.
AU - A Reynolds
AU - C Scharf
AU - Lui G Forni
AU - T Y Koo
AU - S Büttner
AU - V Humbert
AU - J Kielstein
AU - D Kindgen-Milles
AU - A Meiser
AU - S Mitzner
AU - Z Molnar
AU - V Premuzic
AU - M Soledad Taborda-Küpper
AU - L Weidhase
AU - A Kribben
PY - 2026
DA - 2026/10/15
JO - BMC nephrology
DO - 10.1186/s12882-026-05371-5
UR - https://europepmc.org/article/MED/42963778
AB - Background In patients with severe rhabdomyolysis, active myoglobin elimination employing extracorporeal hemoadsorption has been used as a potentially beneficial adjunctive measure. However, data remains scarce regarding the biochemical and clinical effects of this approach. Our aim was to summarize the currently available literature as well as examine the available data on myoglobin and creatine kinase (CK) concentrations in patients with severe rhabdomyolysis before-and-after the use of extracorporeal hemoadsorption.Methods A systematic literature search was performed on 6th February 2025. Where data was available analyses were conducted to assess changes in plasma myoglobin and CK concentrations before-and-after CytoSorb® (CS) hemoadsorption. Non-controlled studies and case reports were analysed via a pooled data analysis comparing myoglobin and CK concentrations before-and-after CS treatment. Controlled studies were analysed via a random-effects meta-analysis to assess CS intervention effect compared to standard treatment.Results A systematic review of literature highlighted 18 publications on the use of CS hemoadsorption in patients with rhabdomyolysis. 14 publications were included in a pooled data analysis; all reported data on myoglobin concentrations (n = 75) and 10 included measurements for CK concentration (n = 71) pre-and-post CS therapy. There was a median absolute myoglobin reduction of 6975 [IQR 1089-18,381] µg/L, resulting in a median 31.04% decrease [IQR 4.68-47.41] following CS use. CK was associated with a median absolute reduction of 380 [IQR - 2682-2720] U/L and a median 12.44% decrease [IQR: -28.08-32.89] after CS therapy. Four controlled studies were identified and included for meta-analysis, of which all included data on myoglobin concentrations (n = 107) and 3 included CK concentrations pre-and-post use of CS therapy (n = 88). CS treatment was associated with a statistically significant post-treatment myoglobin concentration that was - 5062 µg/L (95% CI: -9438 to -687; p = 0.02) lower than that observed with standard treatment. Although CK concentrations decreased in both groups, the final post-treatment CK concentration was 4703 U/L (95% CI: -171 to 9577; p = 0.06) higher in the CS group than in the standard treatment group.Conclusions Based on current limited evidence, this study suggests that CS therapy may be associated with reductions in circulating myoglobin concentrations in patients with severe rhabdomyolysis. However, the certainty of evidence is low, the effect on CK is unclear, and it remains to be determined if biochemical reductions in CK or myoglobin translate to improved clinical outcomes.
SN - 1471-2369
ER -