Do hemoperfusion cartridges remove what they claim? An ex vivo comparison of clinically used hemoperfusion adsorbents

Extracorporeal hemoperfusion cartridges are increasingly used as adjunctive therapies in patients with sepsis and hyperinflammatory states. Several commercially available devices claim to remove inflammatory mediators or endotoxin from the circulation, but independent comparative data on their adsorption performance remain scarce. We therefore performed a systematic head-to-head comparison of three clinically used hemoperfusion cartridges. Three hemoperfusion devices (CytoSorb 300, Jafron HA380, and Efferon LPS) were evaluated in complementary ex vivo whole-blood models combining static adsorption and dynamic recirculating hemoperfusion. Endotoxin-stimulated human blood was exposed to the adsorbents, and time-dependent changes in inflammatory mediators (IL-6, TNF-α, IL-1β, IL-10, IL-18, and procalcitonin), endotoxin and coagulation parameters were quantified. Significant differences in adsorption performance were observed among the tested devices. CytoSorb 300 consistently showed the strongest and most rapid removal of inflammatory mediators in both experimental models. Jafron HA380 exhibited moderate adsorption capacity, whereas the Efferon LPS adsorbent demonstrated little or no removal of most cytokines and no detectable endotoxin clearance. Notably, IL-1β and IL-18 concentrations increased significantly during treatment with the Efferon LPS adsorbent, suggesting potential activation of inflammasome-associated inflammatory pathways. In addition, CytoSorb 300 and Efferon LPS reduced coagulation-related proteins, whereas HA380 released measurable amounts of heparin during pre-treatment. This independent comparative study reveals marked differences in mediator adsorption among clinically used hemoperfusion devices. CytoSorb 300 achieved consistent and broad cytokine removal, whereas HA380 showed moderate efficacy. In contrast, the Efferon LPS adsorbent failed to demonstrate meaningful removal of cytokines or endotoxin under the tested conditions. These findings highlight the need for rigorous independent evaluation of blood purification devices to critically assess their performance and clinical relevance.