Background and objectives: Sepsis and septic shock are critical health emergencies with high morbidity and mortality rates, often triggered by infections. The study investigates Polymyxin B-immobilized fiber column hemoperfusion (PMX-HP) as a supplementary therapy, evaluating its efficacy in critically ill patients with sepsis or septic shock, and determining the optimal treatment protocol.
Methods: This study conducted a systematic review across multiple databases, including PubMed, EMBASE, Cochrane Library, Web of Science, and several Chinese databases up to September 21, 2023. We applied strict inclusion and exclusion criteria to filter relevant studies. The evaluation employed a Bayesian random effects model within a network meta-analysis framework, utilizing Stata 17 for statistical analysis.
Results: From a total of 1,669 papers, 35 studies involving 12,844 patients were selected. Assessing the primary outcome of 28-day mortality, all PMX-HP treatments demonstrated a significant reduction in mortality, with a pooled risk ratio (RR) of 1.19 (95% CI: 1.08–1.31). The optimal regimen, based on the surface under the cumulative ranking curve (SUCRA), was PMX-HP for 2 hours twice daily (SUCRA 0.403). Secondary outcomes included changes in the Sequential Organ Failure Assessment (SOFA) score, inotropic score, C-reactive protein (CRP), and ICU-free days. The PMX-HP treatment notably improved SOFA scores in 7 studies (593 patients) with a pooled RR of 2.57 (95% CI: 2.11–3.04). For inotropic support, PMX-HP showed a pooled RR of 16.24 (95% CI: 12.76–19.71). In reducing CRP levels, shorter PMX-HP sessions (2 hours, once or twice daily) significantly reduced CRP, while the 4-hour regimen was preferred when extending treatment duration. Prolonged treatments also increased ICU-free days, with PMX-HP exceeding 4 hours showing the highest efficacy (SUCRA 0.801).
Conclusion: PMX-HP significantly enhances survival among adults with severe infections or sepsis/septic shock. The 2-hour regimen administered twice a day was particularly effective. These findings provide crucial insights for refining PMX-HP treatment strategies, highlighting its potential as a valuable adjunct therapy in managing severe sepsis.