In the Journals

Polymyxin B hemoperfusion fails to improve survival in septic shock

Polymyxin B hemoperfusion treatment plus conventional medical therapy was not effective in reducing mortality at 28 days among patients with septic shock and high endotoxin activity, according to research published in JAMA.

“Polymyxin B hemoperfusion reduces blood endotoxin levels in sepsis,” R. Phillip Dellinger, MD, MSc, from Cooper University Hospital and Cooper Medical School of Rowan University, and colleagues wrote. “Endotoxin activity can be measured in blood with a rapid assay. Treating patients with septic shock and elevated endotoxin activity using polymyxin B hemoperfusion may improve clinical outcomes.”

Dellinger and colleagues conducted a multicenter, randomized clinical trial to investigate if polymyxin B hemoperfusion plus conventional medical therapy improves survival among 450 patients with septic shock and an endotoxin activity assay level of 0.6 or higher (mean age, 59.8 years; 39.3% women), compared with conventional therapy alone.

Participants were randomly assigned to receive polymyxin B hemoperfusion treatments (90 to 120 minutes) plus standard therapy (n = 224) or sham hemoperfusion plus standard therapy (n = 226).

The researchers found that there was no significant difference in mortality at 28 days between participants receiving polymyxin B hemoperfusion than those receiving sham treatments (37.7% vs. 34.5%; risk difference = 3.2%; 95% CI, –5.7 to 12; RR = 1.09; 95% CI, 0.85-1.39). These results were similar among a subgroup of participants with a multiple organ dysfunction score of more than 9, with 44.5% of those in the treatment group dying at 28 days compared with 43.9% in the sham group (risk difference = 0.6%; 95% CI, –10.8 to 11.9; RR = 1.01; 95% CI, 0.78-1.31).

There were 264 reports of serious adverse events among all participants, with 65.1% of those in the treatment group and 57.3% of those in the sham group experiencing such events. The most common serious adverse events included worsening of sepsis (10.8% treatment group vs. 9.1% sham group) and worsening of septic shock (6.6% treatment group vs. 7.7% sham group).

“The findings suggest that polymyxin B hemoperfusion should not be used with the goal of improving survival in critically ill patients with septic shock,” Dellinger and colleagues concluded. – by Alaina Tedesco

 

Disclosure: The authors report no relevant financial disclosures.

Polymyxin B hemoperfusion treatment plus conventional medical therapy was not effective in reducing mortality at 28 days among patients with septic shock and high endotoxin activity, according to research published in JAMA.

“Polymyxin B hemoperfusion reduces blood endotoxin levels in sepsis,” R. Phillip Dellinger, MD, MSc, from Cooper University Hospital and Cooper Medical School of Rowan University, and colleagues wrote. “Endotoxin activity can be measured in blood with a rapid assay. Treating patients with septic shock and elevated endotoxin activity using polymyxin B hemoperfusion may improve clinical outcomes.”

Dellinger and colleagues conducted a multicenter, randomized clinical trial to investigate if polymyxin B hemoperfusion plus conventional medical therapy improves survival among 450 patients with septic shock and an endotoxin activity assay level of 0.6 or higher (mean age, 59.8 years; 39.3% women), compared with conventional therapy alone.

Participants were randomly assigned to receive polymyxin B hemoperfusion treatments (90 to 120 minutes) plus standard therapy (n = 224) or sham hemoperfusion plus standard therapy (n = 226).

The researchers found that there was no significant difference in mortality at 28 days between participants receiving polymyxin B hemoperfusion than those receiving sham treatments (37.7% vs. 34.5%; risk difference = 3.2%; 95% CI, –5.7 to 12; RR = 1.09; 95% CI, 0.85-1.39). These results were similar among a subgroup of participants with a multiple organ dysfunction score of more than 9, with 44.5% of those in the treatment group dying at 28 days compared with 43.9% in the sham group (risk difference = 0.6%; 95% CI, –10.8 to 11.9; RR = 1.01; 95% CI, 0.78-1.31).

There were 264 reports of serious adverse events among all participants, with 65.1% of those in the treatment group and 57.3% of those in the sham group experiencing such events. The most common serious adverse events included worsening of sepsis (10.8% treatment group vs. 9.1% sham group) and worsening of septic shock (6.6% treatment group vs. 7.7% sham group).

“The findings suggest that polymyxin B hemoperfusion should not be used with the goal of improving survival in critically ill patients with septic shock,” Dellinger and colleagues concluded. – by Alaina Tedesco

 

Disclosure: The authors report no relevant financial disclosures.