Treatment with a polymyxin B filter to capture endotoxin in sepsis patients: is there a signal for therapeutic efficacy?

Excerpt

The discovery of endotoxin, a key component of the membrane of Gram negative bacteria, as one of the main pathogen-associated molecular patterns associated with impaired clinical outcome [1] prompted the hypothesis that ‘blood purification’ might be of clinical benefit for patients with sepsis. Polystyrene fiber filters coated with polymyxin B bind endotoxin avidly. Apart from many case series (summarized in a meta-analysis of trials primarily from Japanese origin, suggesting a survival benefit for patients treated with polymyxin B hemoperfusion [2]), only two prospective randomized controlled clinical trials (RCTs) were conducted. Both trials had shortcomings. The EUPHAS trial [3] was small (n = 64) and early termination increased the risk of type I errors [4], and while the ABDOMIX RCT (n = 232) [5] was open-label, disease severity and overall mortality were moderate and incomplete PMX treatment sessions occurred in 11% of the patients. Plasma endotoxin levels were not measured in either RCT. …