Cleaning the Blood: The Complex Puzzle of Treating Sepsis

Sepsis remains a primary cause of death worldwide, characterised by the body’s dysregulated response to infection. While Extracorporeal Blood Purification (EBP) therapies aim to filter out the circulating mediators driving this chaos, robust evidence for their efficacy is still missing.

A major hurdle is the immune system’s complexity; it is both dynamic and compartmentalised. Consequently, broadly removing molecules can backfire—potentially stripping away protective anti-inflammatory mediators or clearing essential drugs from the system. Even selective approaches, such as removing specific bacterial toxins, face significant challenges regarding proper dosing and patient selection. Clinical trials have produced conflicting results, with some even hinting at harm due to inconsistent protocols and insufficient patient phenotyping.

The review suggests that the current ‘one-size-fits-all’ approach is flawed. Instead, the future of EBP lies in precision: utilising real-time immune monitoring and biomarker-driven stratification to determine exactly who will benefit. Until high-quality randomised controlled trials can validate these individualised therapies, EBP requires a cautious, scientific re-evaluation.