多粘菌素B固定化纤维柱对感染性休克无效吗？关于EUPHRATES试验新闻稿的讨论。
Is polymyxin B-immobilized fiber column ineffective for septic shock? A discussion on the press release for EUPHRATES trial.
作者信息
Iba Toshiaki, Fowler Lucy
机构信息
Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421 Japan.
University of Birmingham, Birmingham, UK.
出版信息
J Intensive Care. 2017 Jul 3;5:40. doi: 10.1186/s40560-017-0236-x. eCollection 2017.
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" ( = 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 ( = 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.
摘要
多粘菌素B固定化（PMX）纤维柱治疗感染性休克的疗效仍存在争议。最近，“评估多粘菌素B血液灌流在成人内毒素血症和感染性休克治疗的随机对照试验（EUPHRATES）”的试验结果已作为新闻稿公布。根据该报告，在“符合方案人群”（n = 244，31.9%对36.9%）中，死亡率差异不到5%，且下降无统计学意义。然而，在多器官功能障碍评分超过9且EAA在0.6至0.9之间的难治性休克患者中，当他们接受两次使用PMX纤维柱的血液灌流时，28天死亡率降低了10.7%（n = 0.0474）。由于这种有利效果是从“事后”分析中获得的，因此期待进一步的研究。
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