Skip to main content

Table 4 The main studies describing the effectiveness/limitations of the polymyxin B-immobilized fiber column

From: Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

  European pilot study (2005) [37] EUPHAS (2009) [38] Japan Registry (2014) [41] ABDO-MIX (2015) [39] Japan Registry (2016) [40] EUPHAS 2 (2016) [42]
Study design Multicenter, open-label, pilot, RCT Multicenter, open-label, prospective RCT Propensity-matched analysis Multicenter, prospective RCT Propensity-matched analysis Retrospective study
Study population (n) 36 patients with intra-abdominal sepsis 64 patients with intra-abdominal sepsis or septic shock PMX = 642 intra-abdominal sepsis patients vs 590 propensity score-matched pairs 232 patients with intra-abdominal septic shock/peritonitis Septic shock patients with CRRT-requiring AKI 357 patients with suspected Gram-negative sepsis
EAA assessment Measured Not measured Not measured Not measured Not measured Some centers
Prescribed dose 1 session (2 h) 2 sessions (2 h) 1–2 sessions 1–2 sessions (2 h) 1–2 sessions 1–2 sessions (2 h)
Timing (h) 24–48 (from diagnosis) 24 (from abdominal surgery) 24 (from surgery) 12 (from surgery) 24 (from starting CRRT) 24–48 (from diagnosis)
Survival/ mortality Mortality, 29% in the PMX group vs 28% in the control group (p = 0.749) • PMX group had a significant reduction in 28-day mortality (adjusted HR 0.36; 95% CI 0.16–0.80; p = 0.01)
• PMX group had a significant reduction in hospital mortality rate (adjusted HR 0.43; 95% CI 0.21–0.90; p = 0.026)
28-day mortality was 17.1% in the treatment group and 16.3% in the
control group (p = 0.696)
• 28-day mortality 27.7% in the treatment group vs 19.5% in the control group (p = 0.14)
• 90-day mortality was 33.6% in the treatment group vs 24% in the control group (p = 0.10)
• The 28-day mortality was 40.2% in the treatment group and 46.8% in the control group (p = 0.003)
• 28-day mortality in patients receiving 2 PMX was 35.7% vs 42.6% in the group treated with one session
• 28-day survival 54.5%
• ICU survival 55.2%
• Hospital survival 50%
• Patients with abdominal sepsis treated within 24 h survival 64.5%
Length of ICU stay 13.2 ± 9.4 days in the PMX; vs 17.0 ± 9.4 days No significant difference No significant difference
Hemodynamics Significant improvement in the PMX group Significant reduction in VP dose in the treatment group No significant difference No significant difference
Other results No significant difference in the change of IL-6 levels compared to baseline
Safety Higher AE (mainly change in vitals in the treatment arm) No adverse events reported 6 severe adverse events (hemorrhagic episodes in the treatment group)
Platelet drop
Significant platelet drop with no clinical implications
  1. CRRT continuous renal replacement therapy, EAA endotoxin activity assay, PMX polymyxin, AE adverse event, VP vasopressors