The effect of polymyxin B hemoperfusion on prognosis of patients with sepsis and septic shock: a meta-analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

TIAN Xingguo ¹ ,  CHEN Zhi ² , HE Huiwei ² , YANG Chunli ²

1. Department of Internal Medicine, Shangrao Maternal and Child Health Hospital, Shangrao, Jiangxi 334000, P. R. China;
2. Department of Critical Care Medicine, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi 330006, P. R. China;

Corresponding author：

CHEN Zhi, Email: zhichen@tongji.edu.cn

Keywords：

Polymyxin B; Hemoperfusion; Sepsis; Septic Shock; Mortality; Meta-analysis

DOI：

10.7507/1671-6205.201901033

Video：

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Objective To investigate the effect of polymyxin B hemoperfusion on the prognosis of patients with sepsis and septic shock by meta-analysis.Methods Supplemented by manual search and document traceability, the US National Library of Medicine Pubmed, the Dutch Medical Abstracts Embase database, and the Cochrane clinical trial database were searched. Randomized controlled trials (RCTs) were collected from January 1998 to October 2018 for the treatment of sepsis and septic shock with polymyxin B hemoperfusion, only limited to English publications. The collected RCTs were evaluated and the prognosis of patients with sepsis and septic shock was analyzed by the Cochrane Collaboration.Results Finally six RCTs were included, and a total of 926 patients were analyzed, with 471 patients in the polymyxin B hemoperfusion group and 455 patients in the control group. The mortality rate was 36.3% (171/471) in the polymyxin B hemoperfusion group and 39.1% (178/455) in the control group. Hemoperfusion with polymyxin B could not reduce the patient mortality (RR=0.80, 95% CI 0.56 to 1.15, P=0.233). A subgroup analysis was taken on the patients with moderate to severe septic shock. Four RCTs were included in total and 418 patients were analyzed, with 207 patients in the polymyxin B hemoperfusion group and 211 in the control group. The mortality rate was 38.65% (80/207) in the polymyxin B hemoperfusion group and 50.71% (107/211) in the control group were. The hemoperfusion of polymyxin B could significantly reduce the mortality of patients with moderate to severe septic shock (RR=0.70, 95% CI 0.52 to 0.96, P=0.025).Conclusions Olymyxin B hemoperfusion can not improve the prognosis of patients with sepsis and septic shock. However, compared with conventional treatment, polymyxin B hemoperfusion can improve the 28-day mortality rate of patients of severe septic shock. Due to the limit number of randomized controlled trials, more high-quality trials are needed to a further confirmation.

Citation： TIAN Xingguo, CHEN Zhi, HE Huiwei, YANG Chunli. The effect of polymyxin B hemoperfusion on prognosis of patients with sepsis and septic shock: a meta-analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(1): 16-21. doi: 10.7507/1671-6205.201901033 Copy

1.	American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med, 1992, 20(6): 864-874.
2.	Stevenson EK, Rubenstein AR, Radin GT, et al. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med, 2014, 42(3): 625-631.
3.	Heumann D, Glauser MP, Calandra T. Molecular basis of host-pathogen interaction in septic shock. Curr Opin Microbiol, 1998, 1(1): 49-55.
4.	Danner RL, Elin RJ, Hosseini JM, et al. Endotoxemia in human septic shock. Chest, 1991, 99(1): 169-175.
5.	Davies B, Cohen J. Endotoxin removal devices for the treatment of sepsis and septic shock. Lancet Infect Dis, 2011, 11(1): 65-71.
6.	Nemoto H, Nakamoto H, Okada H, et al. Newly developed immobilized polymyxin B fibers improve the survival of patients with sepsis. Blood Purif, 2001, 19(4): 361-368.
7.	Chang T, Tu YK, Lee CT, et al. Effects of polymyxin B hemoperfusion on mortality in patients with severe sepsis and septic shock: a systemic review, meta-analysis update, and disease severity subgroup meta-analysis. Crit Care Med, 2017, 45(8): e858-e864.
8.	Kuriyama A, Katsura M, Urushidani S, et al. Impact of polymyxin B hemoperfusion in the treatment of patients with sepsis and septic shock: a meta-analysis of randomized controlled trials. Ann Transl Med, 2018, 6(11): 206.
9.	Suzuki H, Nemoto H, Nakamoto H, et al. Continuous hemodiafiltration with polymyxin-B immobilized fiber is effective in patients with sepsis syndrome and acute renal failure. Ther Apher, 2002, 6(3): 234-240.
10.	Vincent JL, Laterre PF, Cohen J, et al. A pilot-controlled study of a polymyxin B-immobilized hemoperfusion cartridge in patients with severe sepsis secondary to intra-abdominal infection. Shock, 2005, 23(5): 400-405.
11.	Cruz DN, Antonelli M, Fumagalli R, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA, 2009, 301(23): 2445-2452.
12.	Payen DM, Guilhot J, Launey Y, et al. ABDOMIX Group: early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: a multicenter randomized control trial. Intensive Care Med, 2015, 41(6): 975-984.
13.	Dellinger RP, Bagshaw SM, Antonelli M, et al. Effect of targeted polymyxin B hemoperfusion on 28-day mortality in patients with septic shock and elevated endotoxin level: The EUPHRATES Randomized Clinical Trial. JAMA, 2018, 320(14): 1455-1463.
14.	Linde-Zwirble WT, Angus DC. Severe sepsis epidemiology: sampling, selection, and society. Crit Care, 2004, 8(4): 222-226.
15.	Dombrovskiy VY, Martin AA, Sunderram J, et al. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med, 2007, 35(5): 1244-1250.
16.	Ono S, Tsujimoto H, Matsumoto A, et al. Modulation of human leukocyte antigen-DR on monocytes and CD16 on granulocytes in patients with septic shock using hemoperfusion with polymyxin B-immobilized fiber. Am J Surg, 2004, 188(2): 150-156.
17.	Cruz DN, Perazella MA, Bellomo R, et al. Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Crit Care, 2007, 11(2): R47.
18.	邱晓华, 刘松桥, 郭凤梅, 等. 多黏菌素 B 血液灌流对严重感染患者预后影响的荟萃分析. 中华内科杂志, 2011, 50(5): 316-321.
19.	Saito N, Sugiyama K, Ohnuma T, et al. Efficacy of polymyxin B-immobilized fiber hemoperfusion for patients with septic shock caused by Gram-negative bacillus infection. PLoS One, 2017, 12(3): e0173633.
20.	Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock. Crit Care Med, 2004, 32(3): 858-873.

1. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med, 1992, 20(6): 864-874.
2. Stevenson EK, Rubenstein AR, Radin GT, et al. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med, 2014, 42(3): 625-631.
3. Heumann D, Glauser MP, Calandra T. Molecular basis of host-pathogen interaction in septic shock. Curr Opin Microbiol, 1998, 1(1): 49-55.
4. Danner RL, Elin RJ, Hosseini JM, et al. Endotoxemia in human septic shock. Chest, 1991, 99(1): 169-175.
5. Davies B, Cohen J. Endotoxin removal devices for the treatment of sepsis and septic shock. Lancet Infect Dis, 2011, 11(1): 65-71.
6. Nemoto H, Nakamoto H, Okada H, et al. Newly developed immobilized polymyxin B fibers improve the survival of patients with sepsis. Blood Purif, 2001, 19(4): 361-368.
7. Chang T, Tu YK, Lee CT, et al. Effects of polymyxin B hemoperfusion on mortality in patients with severe sepsis and septic shock: a systemic review, meta-analysis update, and disease severity subgroup meta-analysis. Crit Care Med, 2017, 45(8): e858-e864.
8. Kuriyama A, Katsura M, Urushidani S, et al. Impact of polymyxin B hemoperfusion in the treatment of patients with sepsis and septic shock: a meta-analysis of randomized controlled trials. Ann Transl Med, 2018, 6(11): 206.
9. Suzuki H, Nemoto H, Nakamoto H, et al. Continuous hemodiafiltration with polymyxin-B immobilized fiber is effective in patients with sepsis syndrome and acute renal failure. Ther Apher, 2002, 6(3): 234-240.
10. Vincent JL, Laterre PF, Cohen J, et al. A pilot-controlled study of a polymyxin B-immobilized hemoperfusion cartridge in patients with severe sepsis secondary to intra-abdominal infection. Shock, 2005, 23(5): 400-405.
11. Cruz DN, Antonelli M, Fumagalli R, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA, 2009, 301(23): 2445-2452.
12. Payen DM, Guilhot J, Launey Y, et al. ABDOMIX Group: early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: a multicenter randomized control trial. Intensive Care Med, 2015, 41(6): 975-984.
13. Dellinger RP, Bagshaw SM, Antonelli M, et al. Effect of targeted polymyxin B hemoperfusion on 28-day mortality in patients with septic shock and elevated endotoxin level: The EUPHRATES Randomized Clinical Trial. JAMA, 2018, 320(14): 1455-1463.
14. Linde-Zwirble WT, Angus DC. Severe sepsis epidemiology: sampling, selection, and society. Crit Care, 2004, 8(4): 222-226.
15. Dombrovskiy VY, Martin AA, Sunderram J, et al. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med, 2007, 35(5): 1244-1250.
16. Ono S, Tsujimoto H, Matsumoto A, et al. Modulation of human leukocyte antigen-DR on monocytes and CD16 on granulocytes in patients with septic shock using hemoperfusion with polymyxin B-immobilized fiber. Am J Surg, 2004, 188(2): 150-156.
17. Cruz DN, Perazella MA, Bellomo R, et al. Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Crit Care, 2007, 11(2): R47.
18. 邱晓华, 刘松桥, 郭凤梅, 等. 多黏菌素 B 血液灌流对严重感染患者预后影响的荟萃分析. 中华内科杂志, 2011, 50(5): 316-321.
19. Saito N, Sugiyama K, Ohnuma T, et al. Efficacy of polymyxin B-immobilized fiber hemoperfusion for patients with septic shock caused by Gram-negative bacillus infection. PLoS One, 2017, 12(3): e0173633.
20. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock. Crit Care Med, 2004, 32(3): 858-873.

Chinese Journal of Respiratory and Critical Care Medicine

The effect of polymyxin B hemoperfusion on prognosis of patients with sepsis and septic shock: a meta-analysis

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