Granulocyte and monocyte adsorption therapy in sepsis: a propensity score-matched analysis

Background: Granulocyte and monocyte adsorption therapy has been explored as an adjunctive treatment for sepsis due to its potential to modulate excessive systemic inflammation. However, clinical evidence characterizing its real-world use for sepsis remains limited. This study aimed to conduct an exploratory comparative assessment of granulocyte and monocyte adsorption apheresis-direct hemoperfusion (G1-DHP) in patients with sepsis. Methods: We conducted a retrospective comparative study using a prospective multicenter dataset of patients treated with G1-DHP (G-1 trial) and three independent sepsis datasets (Japan Septic Disseminated Intravascular Coagulation [JSEPTIC-DIC], Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma [FORECAST], and Japan Medical Data Center [JMDC]) as controls. Propensity score matching was performed using one-to-one nearest-neighbor matching. The primary outcome was 28-day mortality. Secondary outcomes included ventilator-free period, intensive care unit (ICU)-free period, and improvements in organ dysfunction scores. Ordinal logistic regression and linear regression were used based on outcome characteristics. Results: After matching, the cohorts included 71, 72, and 68 patient pairs for comparisons with JSEPTIC-DIC, FORECAST, and JMDC, respectively. 28-day mortality was significantly lower in the G-1 trial across all matched datasets (G-1 trial vs. JSEPTIC-DIC: 5.6% vs. 23%; G-1 trial vs. FORECAST: 5.6% vs. 28%; G-1 trial vs. JMDC: 5.9% vs. 38%, all P < 0.01). The G-1 trial had a significantly longer ventilator-free period and a trend toward a longer ICU-free period. G1-DHP was also associated with greater observed improvement in Sequential Organ Failure Assessment (SOFA) score by day 7 in comparison to controls. Improvements in liver and coagulation SOFA subscores were particularly notable. Conclusions: In this multi-dataset analysis, patients treated with G1-DHP showed lower mortality and more favorable clinical outcomes in comparison to external controls. These exploratory findings provide preliminary insights into the potential role of G1-DHP as an immunomodulatory approach in sepsis and warrant further evaluation in prospective studies.