Effects of CytoSorb® hemoadsorption therapy on serum myoglobin and creatine kinase levels in severe rhabdomyolysis: a systematic review and meta-analysis

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. 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. 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. 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.