Polymyxin B-immobilized hemoperfusion and mortality in critically ill adult patients with sepsis/septic shock: a systematic review with meta-analysis and trial sequential analysis |
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| Authors: | Tomoko Fujii author-information" >,Riki Ganeko,Yuki Kataoka,Toshi A. Furukawa,Robin Featherstone,Kent Doi,Jean-Louis Vincent,Daniela Pasero,René Robert,Claudio Ronco,Sean M. Bagshaw |
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| Affiliation: | 1.Department of Epidemiology and Preventive Medicine,Kyoto University Graduate School of Medicine,Kyoto,Japan;2.Japan Society for the Promotion of Science,Tokyo,Japan;3.Department of Surgery,Kyoto University Hospital,Kyoto,Japan;4.Department of Respiratory Medicine,Hyogo Prefectural Amagasaki General Medical Center,Amagasaki,Japan;5.Department of Health Promotion and Human Behavior,Kyoto University Graduate School of Medicine,Kyoto,Japan;6.Department of Pediatrics, Alberta Research Center for Health Evidence (ARCHE),University of Alberta,Alberta,Canada;7.Department of Emergency and Critical Care Medicine,The University of Tokyo Hospital,Tokyo,Japan;8.Department of Intensive Care, Erasme University Hospital,Unversité Libre de Bruxelles,Brussels,Belgium;9.Department of Anesthesia and Intensive Care Medicine, San Giovanni Battista Hospital,University of Turin,Turin,Italy;10.Service de Réanimation Médicale, CHU-Poitiers,University of Poitiers,Poitiers,France;11.Department of Nephrology Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV),San Bortolo Hospital,Vicenza,Italy;12.Department of Critical Care Medicine, Faculty of Medicine and Dentistry,University of Alberta,Edmonton,Canada |
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| Abstract: | PurposePolymyxin B-immobilized hemoperfusion (PMX-HP) is an adjuvant therapy for sepsis or septic shock that clears circulating endotoxin. Prior trials have shown that PMX-HP improves surrogate endpoints. We aimed to conduct an evidence synthesis to evaluate the efficacy and safety of PMX-HP in critically ill adult patients with sepsis or septic shock.MethodsWe searched for randomized controlled trials (RCTs) in MEDLINE, EMBASE, the Cochrane Library, the Health Technology Assessment Database, CINAHL, “Igaku Chuo Zasshi”, the National Institute of Health Clinical Trials Register, the World Health Organization International Clinical Trials Registry Platform, the University Hospital Medical Information Network Clinical Trials Registry, the reference lists of retrieved articles, and publications by manufacturers of PMX-HP. The primary outcomes were 28-day all-cause mortality, the number of patients with at least one serious adverse event, and organ dysfunction scores. The GRADE methodology for the certainty of evidence was used.ResultsSix trials (857 participants; weighted mean age 62.5 years) proved eligible. Patient-oriented primary outcomes were assessed. The pooled risk ratio (RR) for 28-day mortality associated with PMX-HP was 1.03 [95% confidence interval (CI) 0.78–1.36; I 2 = 25%; n = 797]. The pooled RR for adverse events was 2.17 (95% CI 0.68–6.94; I 2 = 0%; n = 717). Organ dysfunction scores over 24–72 h after PMX-HP treatment did not change significantly (standardized mean difference ? 0.26; 95% CI ? 0.64 to 0.12; I 2 = 78%; n = 797). The certainty of the body of evidence was judged as low for both benefit and harm using the GRADE methodology.ConclusionsThere is currently insufficient evidence to support the routine use of PMX-HP to treat patients with sepsis or septic shock.RegistrationPROSPERO International Prospective Register of Systematic Reviews (CRD42016038356). |
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