ArticleCritical care (London, England)2023
Targeted therapy using polymyxin B hemadsorption in patients with sepsis: a post-hoc analysis of the JSEPTIC-DIC study and the EUPHRATES trial.
Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
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Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 43 citations in OpenAlex.
- Effects on mortality of different blood purification techniques in sepsis patients: an umbrella review of systematic reviews and meta-analyses.Renal failure · 2026Pooled 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
- Timing of hemoadsorption in sepsis: redefining early through mediator-guided therapy.Journal of intensive care · 2026Review
- Heterogeneity of Clazosentan Benefit after Aneurysmal Subarachnoid Hemorrhage Demonstrated in an Externally Validated Causal Policy Tree.Neurocritical care · 2026Article
- Extracorporeal therapies in sepsis: a comprehensive review of the Selective Cytopheretic Device, Polymyxin B and Seraph cartridges.Renal failure · 2025Review
- Endotoxin Activity Assay-Guided Patient Selection for Polymyxin B Hemoperfusion: Lessons from the TIGRIS Trial and Future Directions.Healthcare (Basel, Switzerland) · 2025Review
- Therapeutic target of high fresh frozen plasma to red blood cell ratio in severe blunt trauma.Critical care (London, England) · 2025Article
- Sepsis-Related Cardiomyopathy: Advances in Diagnosis and Treatment.Reviews in cardiovascular medicine · 2025Review
- Polymyxin B Hemoperfusion for Patients With Septic Shock Requiring High-Dose Norepinephrine: A Multicenter Prospective Cohort Study.Critical care explorations · 2025Article
- Assessing the Heterogeneous Treatment Effects of Glucocorticoids in Infants and Toddlers with Severe Pneumonia.Biomedicines · 2025Article
- Organ Failure, Endotoxin Activity, and Mortality in Septic Shock.Critical care explorations · 2025Observational
- Neutrophil extracellular traps in sepsis: trade-off between pros and cons.Burns & trauma · 2025Review
- Investigating the feasibility of machine learning to guide personalized red blood cell (RBC) transfusion: analyzing the heterogeneity of RBC transfusion in septic patients with hemoglobin levels of 7-9 g/dL based on the causal forest model.Frontiers in pharmacology · 2025Article
- The Emerging Roles and Therapeutic Potential of Unconventional T Cells in Sepsis.Journal of inflammation research · 2025Review
- The transition of the criteria for disseminated intravascular coagulation and the targeted patients in randomized controlled trials over the decades: a scoping review.Thrombosis journal · 2024Article
- Towards personalized medicine: a scoping review of immunotherapy in sepsis.Critical care (London, England) · 2024Article
- Adjunctive immunotherapeutic agents in patients with sepsis and septic shock: a multidisciplinary consensus of 23.Journal of anesthesia, analgesia and critical care · 2024Article
- Current perspectives in the management of sepsis and septic shock.Frontiers in medicine · 2024Review
- Endotoxic Septic Shock: Diagnosis and Treatment.International journal of molecular sciences · 2023Review
- Authors' reply to the comment from Uchida et al.Critical care (London, England) · 2023Article
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Authors and funding
9 authors at 7 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPolymyxin B hemadsorption (PMX-HA) reduces blood endotoxin levels, but characteristics of patients with sepsis likely to benefit from PMX-HA are not well known. We sought to identify patient subgroups likely to benefit from PMX-HA.
methodsWe retrospectively identified 1911 patients with sepsis from a retrospective observational study in Japan (the JSEPTIC-DIC study) and 286 patients with endotoxemic septic shock from a randomized controlled trial in North America that restricted patients to those with high endotoxin activity (the EUPHRATES trial). We applied the machine learning-based causal forest model to the JSEPTIC-DIC cohort to investigate heterogeneity in treatment effects of PMX-HA on 28-day survival after adjusting for potential confounders and ascertain the best criteria for PMX-HA use. The derived criteria for targeted therapy by PMX-HA were validated using the EUPHRATES trial cohort.
resultsThe causal forest model revealed heterogeneity in treatment effects of PMX-HA. Since patients having higher treatment effects were more likely to have severe coagulopathy and hyperlactatemia, we identified the potential treatment targets of PMX-HA as patients with PT-INR > 1.4 or lactate > 3 mmol/L. In the EUPHRATES trial cohort, PMX-HA use on the targeted subpopulation (75% of all patients) was significantly associated with higher 28-day survival (PMX-HA vs. control, 68% vs. 52%; treatment effect of PMX-HA, + 16% [95% CI + 2.2% to + 30%], p = 0.02).
conclusionsAbnormal coagulation and hyperlactatemia in septic patients with high endotoxin activity appear to be helpful to identify patients who may benefit most from PMX-HA. Our findings will inform enrollment criteria for future interventional trials targeting patients with coagulopathy and hyperlactatemia.
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