Is polymyxin B-immobilized fiber column ineffective for septic shock? A discussion on the press release for EUPHRATES trial

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.