Li Chao, Zhang Jinlian, Yang Ping, Wang Ranran, Chen Ting, Li Lixia
Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Heliyon. 2024 Jun 27;10(13):e33735. doi: 10.1016/j.heliyon.2024.e33735. eCollection 2024 Jul 15.
Polymyxin B-immobilized hemoperfusion (PMX-HP) is a therapeutic strategy for removing circulating endotoxins from patients with sepsis or septic shock. However, the survival advantage of PMX-HP treatment remains controversial for patients with sepsis/septic shock. Therefore, this study collected all the clinical trials to assess the effect and the safety of PMX-HP treatment.
PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for eligible trials fromtheir inception through June 30, 2023. All clinical trials that investigated the effect of polymyxin B hemoperfusion in patients who died with sepsis or septic shock within 28-day mortality were eligible. The Cochrane Risk of Bias Assessment instrument and the ROBINS-I tool were used to assess the risk of bias.
A total of 30 trials, including 25680 adult patients, were included. PMX-HP decreased 28-day mortality (OR 0.75, 95 % CI 0.65-0.88; p＜0.00001). Subgroup analysis revealed that 28-day mortality was significantly reduced after PMX-HP treatment in the mixed infection site group and in the age under 70 years old group. PMX-HP might also lower endotoxin levels (MD -1.22, 95 % CI -1.62 - 0.81, p < 0.00001) and improve SOFA scores (MD -2.11, 95 % CI -3.80- 0.43, p = 0.01). PMX-HP was not linked to the development of significant adverse events (p = 0. 05).
Our findings suggest that PMX-HP therapy can reduce 28-day mortality in individuals with sepsis or septic shock. The therapeutic effect may be due to the ability of PMX-HP to lower endotoxin levels and enhance hemodynamics. However, further assessment of the clinical effects of PMX-HP on sepsis or septic shock is required.
多黏菌素B固定化血液灌流（PMX-HP）是一种用于清除脓毒症或脓毒性休克患者循环内毒素的治疗策略。然而，PMX-HP治疗对脓毒症/脓毒性休克患者的生存优势仍存在争议。因此，本研究收集了所有临床试验，以评估PMX-HP治疗的效果和安全性。
检索PubMed、EMBASE和Cochrane对照试验中央注册库，查找从创建至2023年6月30日的符合条件的试验。所有调查多黏菌素B血液灌流对28天内死于脓毒症或脓毒性休克患者影响的临床试验均符合条件。采用Cochrane偏倚风险评估工具和ROBINS-I工具评估偏倚风险。
共纳入30项试验，包括25680例成年患者。PMX-HP降低了28天死亡率（比值比0.75，95%可信区间0.65-0.88；p＜0.00001）。亚组分析显示，在混合感染部位组和70岁以下年龄组中，PMX-HP治疗后28天死亡率显著降低。PMX-HP还可能降低内毒素水平（平均差-1.22，95%可信区间-1.62-0.81，p＜0.00001）并改善序贯器官衰竭评估（SOFA）评分（平均差-2.11，95%可信区间-3.80-0.43，p=0.01）。PMX-HP与严重不良事件的发生无关（p=0.05）。
我们的研究结果表明，PMX-HP治疗可降低脓毒症或脓毒性休克患者的28天死亡率。治疗效果可能归因于PMX-HP降低内毒素水平和增强血流动力学的能力。然而，需要进一步评估PMX-HP对脓毒症或脓毒性休克的临床效果。
