Trial reportIntensive care medicine2018
Polymyxin B hemoperfusion in endotoxemic septic shock patients without extreme endotoxemia: a post hoc analysis of the EUPHRATES trial.
Trial report in Intensive care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 122 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Evaluating the Use of Polymyxin B Hemoperfusion in a Randomized Controlled Trial of Adults Treated for Endotoxemia and Septic Shock
Hemoadsorpion in Patients With Septic Shock: Efficacy and Safety Evaluation. A Pilot Multicenter Randomized Controlled Trial
Who cites it
122 citing papers in PubMed, 3 syntheses or guidelines pooled it, 232 citations in OpenAlex.
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- Predictive enrichment using biomarkers in studies of critically-ill patients with sepsis: a systematic review.Critical care (London, England) · 2025Pooled it
- Extracorporeal Blood Purification with the oXiris® Filter for Patients with Sepsis and Hyperinflammatory Conditions: The Asia-Pacific oXiris Expert Meeting 2024 Consensus Statements.Blood purification · 2025Guideline
- HA-330 hemoadsorption in septic shock requiring high-dose norepinephrine: a multicenter randomized controlled trial (CLEANSE).Critical care (London, England) · 2026Trial
- The effects of extracorporeal blood purification (oXiris®) in patients with cardiogenic shock who require VA-ECMO (CLEAN ECMO): a prospective, open-label, randomized controlled pilot study.Critical care (London, England) · 2025Trial
- [Personalized sepsis therapy and modern trial designs].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026Article
- [Extracorporeal immunomodulation in sepsis : Role, limits, and perspectives of adjuvant blood purification therapies].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026Review
- Polymyxin B hemoadsorption in endotoxic septic shock: ten questions on the Tigris trial.Critical care (London, England) · 2026Article
- Timing of hemoadsorption in sepsis: redefining early through mediator-guided therapy.Journal of intensive care · 2026Review
- Precision therapy for endotoxic septic shock: a step toward personalized treatment from EUPHAS to TIGRIS.Acute and critical care · 2026Article
- Sample size assumptions, timing asymmetries, and endpoint selection limit the interpretability of the CLEANSE hemoadsorption trial in septic shock.Critical care (London, England) · 2026Article
- Mechanistic success and clinical neutrality: lessons from the OXICARD trial.Journal of thoracic disease · 2026Article
- Current and future strategies aiming at reducing catecholamine exposure in septic shock.Critical care (London, England) · 2026Review
- Innovation in sepsis trials: rethinking endpoints, statistics and patient stratification.Intensive care medicine experimental · 2026Review
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- oXiris in severe cardiogenic shock with endotoxemia: interpreting the negative findings of the CLEAN-ECMO trial.Critical care (London, England) · 2026Article
- The Effect of Heparin-Grafted Chitosan-Cellulose Composite Microspheres on the Removal of Endotoxins and Circulating Histones in a Septic Rabbit Model: An In Vivo Study.Biomedicines · 2026Article
- Integration of Polymyxin-B Hemoadsorption Device into a CRRT Circuit for Endotoxic Septic Shock in a Child: A Case Report.Pediatric reports · 2026Article
- Technicalities, current evidence, and clinical indications of hemoadsorption in critically ill children.Pediatric nephrology (Berlin, Germany) · 2026Review
- Differential Impact of Polymyxin B Hemadsorption on Long-Term Mortality in Septic Shock: A Retrospective Analysis of Intra-Abdominal Versus Extra-Abdominal Infections.Artificial organs · 2026Article
62 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
Abstract
purposeThe EUPHRATES trial examined the impact of polymyxin B hemoperfusion (PMX) on mortality in patients with septic shock and endotoxemia, defined as EAA ≥ 0.60. No difference was found in 28-day all-cause mortality. However, the trial showed that in some patients with septic shock the burden of endotoxin activity was extreme (EAA ≥ 0.9). In a post hoc analysis, we evaluated the impact of PMX use in patients with septic shock and endotoxin activity measured between 0.6-0.89.
methodsPost-hoc analysis of the EUPHRATES trial for the 194 patients with EAA ≥ 0.6-0.89 who completed two treatments (PMX or sham). The primary end point was mortality at 28 days adjusted for APACHE II score and baseline mean arterial pressure (MAP). Additional end points included changes in MAP, cumulative vasopressor index (CVI), median EAA reduction, ventilator-free days (VFD), dialysis-free days (DFD) and hospital length of stay. Subpopulations analyzed were site and type of infection and those with norepinephrine dose > 0.1 mcg/kg/min at baseline.
resultsAt 28 days, 23 patients of 88 (26.1%) in the PMX group died versus 39 of 106 (36.8%) in the sham group [risk difference 10.7%, OR 0.52, 95% CI (0.27, 0.99), P = 0.047]. When unadjusted for baseline variables, P = 0.11. The 28-day survival time in the PMX group was longer than for the sham group [HR 0.56 (95% CI 0.33, 0.95) P = 0.03]. PMX treatment compared with sham showed greater change in MAP [median (IQR) 8 mmHg (- 0.5, 19.5) vs. 4 mmHg (- 4.0, 11) P = 0.04] and VFD [median (IQR) 20 days (0.5, 23.5) vs. 6 days (0, 20), P = 0.004]. There were no significant differences in other end points. There was a significant difference in mortality in PMX-treated patients with no bacterial growth on culture [PMX, 6/30 (20%) vs. sham, 13/31 (41.9%), P = 0.005]. The median EAA change in the population was - 12.9% (range: increase 49.2%-reduction 86.3%). The mortality in the above median EAA change group was PMX: 6/38 (15.7%) vs. sham 15/49 (30.6%), P = 0.08.
conclusionsThese hypothesis-generating results, based on an exploratory post hoc analysis of the EUPHRATES trial, suggest measurable responses in patients with septic shock and an EAA ≥ 0.6 to 0.89 on changes in mean arterial pressure, ventilator-free days and mortality.
trial registrationClinicaltrials.gov Identifier: NCT01046669. Funding Spectral Medical Incorporated.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.