C54-18 Iloprost in Adults With Sepsis: Meta-Analysis of Randomized Controlled Trials

Rationale Sepsis is a condition that has been periodically updated to reflect advances in knowledge and emerging evidence. Currently, it is defined as a life-threatening organ dysfunction from dysregulated host response to infection, and it is a leading cause of mortality in intensive care units worldwide. Its management emphasizes antibiotics, source control, and hemodynamic support, but offers limited benefit for microvascular dysfunction and endothelial impairment. Prostacyclin analogs, such as iloprost, may improve these outcomes by enhancing microvascular flow, preserving endothelial integrity, and reducing inflammation, with the potential to translate into lower mortality among critically ill patients. We aimed to evaluate whether iloprost reduces mortality in adults with sepsis. Methods A systematic review was conducted on PubMed, EMBASE, Cochrane, and Web of Science to identify randomized controlled trials (RCTs) comparing iloprost to placebo in adults with sepsis. The primary outcome was all-cause mortality up to 90 days. Secondary outcomes included organ dysfunction, measured by Sequential Organ Failure Assessment (SOFA) scores, and the number of days alive without mechanical ventilation (MV), vasopressors (VSP), renal replacement therapy (RRT), and adverse events (AE). Data were pooled using a random-effects model with risk ratio (RR), mean difference (MD) and difference of medians (DOM). Our statistical analysis was made using R v.4.5.0. Results In three randomized controlled trials including 594 patients with sepsis, iloprost did not reduce mortality up to 90 days compared with placebo (RR 0.96, 95% CI 0.39-2.38, I² = 58.5%, p = 0.87). The pooled analysis showed no significant effects on SOFA scores (MD 0.65, 95% CI -0.21 to 1.52, I² = 0.0%, p = 0.08), mechanical ventilation-free days (MD 15.04, 95% CI -94.60 to 124.68, I² = 91.2%, p = 0.79), vasopressor-free days (MD -0.99, 95% CI -9.07 to 7.08, I² = 48.6%, p = 0.81), or renal replacement therapy-free days (MD -1.45, 95% CI -6.43 to 3.54, I² = 0.0%, p = 0.57). Similarly, iloprost was not associated with a difference in adverse events compared with placebo (RR 1.24, 95% CI 0.12-12.35, I² = 59.6%, p = 0.73). Conclusion Despite a physiological rationale that supports prostacyclin therapy, our data do not show a mortality benefit for iloprost in sepsis. The pooled analysis found no significant differences in up to 90-day mortality, adverse events, organ support-free days, or organ dysfunction scores. Larger studies, potentially stratified by endothelial injury markers, are needed to better understand iloprost’s clinical impact. This abstract is funded by: None