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Is polymyxin B-immobilized fiber column ineffective for septic shock? A discussion on the press release for EUPHRATES
Toshiaki Iba1, Lucy Fowler1,2
1Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421 Japan.
Abstract:
The efficacy of polymyxin B-immobilized (PMX) fiber column on septic shock is still under debate. Recently, the result from "Evaluating the Use of Polymyxin B Hemoperfusion in a Randomized controlled trial of Adults Treated for Endotoxemia and Septic shock (EUPHRATES)" trial has been announced as a press release. According to that report, less than a 5% mortality difference was recognized in the "per protocol population" (n = 244, 31.9 vs. 36.9%) and the decrease was not statistically significant. However, among the patients in refractory shock with a multiple organ dysfunction score of more than 9 and an EAA between 0.6 and 0.9, a 10.7% reduction in 28-day mortality was recognized (p = 0.0474) when they received two sessions of hemoperfusion using the PMX fiber column. Since this favorable effect was obtained from "post hoc" analysis, further study is expected.
Insights
Polymyxin B-immobilized fiber column (PMX) showed no significant mortality benefit in septic shock patients overall. However, a subgroup analysis indicated PMX may reduce mortality in refractory shock with severe organ dysfunction.
Area of Science:
- Critical Care Medicine
- Nephrology
- Infectious Diseases
Background:
- Septic shock management remains challenging, with high mortality rates.
- Polymyxin B-immobilized (PMX) fiber column hemoperfusion is a potential treatment for endotoxemia.
- The EUPHRATES trial investigated PMX efficacy in septic shock, with recent press release results.
Purpose of the Study:
- To evaluate the efficacy of polymyxin B-immobilized (PMX) fiber column hemoperfusion in patients with septic shock.
- To analyze the impact of PMX on mortality in different patient subgroups.
Main Methods:
- The study analyzed data from the EUPHRATES randomized controlled trial.
- A "per protocol" population (n=244) was assessed for mortality differences.
- A subgroup of patients in refractory shock with specific multiple organ dysfunction scores and endotoxin activity assays (EAA) were analyzed post hoc.
Main Results:
- The overall "per protocol" population showed a non-statistically significant mortality difference (31.9% vs. 36.9%) with PMX treatment.
- In a post hoc analysis, patients with refractory shock (multiple organ dysfunction score >9) and EAA between 0.6-0.9 receiving two PMX sessions showed a 10.7% reduction in 28-day mortality (p=0.0474).
Conclusions:
- Polymyxin B-immobilized (PMX) fiber column hemoperfusion did not demonstrate statistically significant efficacy in the overall septic shock population in the EUPHRATES trial.
- Post hoc analysis suggests a potential survival benefit of PMX in a specific subgroup of critically ill septic shock patients with refractory shock and high endotoxemia.
- Further research is warranted to confirm these findings in targeted patient populations.
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