TIGRIS and EUPHRATES eventually join and provide new evidence
Septic shock driven by endotoxemia is associated with high mortality despite advances in supportive care. Polymyxin B hemoperfusion (PMX-HP) selectively removes circulating endotoxin and has shown variable efficacy in randomized trials. While earlier studies, such as EUPHAS, suggested benefit, subse...
| Autores: | , , , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | inglés |
| OAI Identifier: | oai:ddd.uab.cat:326367 |
| Acceso en línea: | https://ddd.uab.cat/record/326367 https://dx.doi.org/urn:doi:10.1186/s40560-025-00835-6 |
| Access Level: | acceso abierto |
| Palabra clave: | Endotoxin Extracorporeal circulation Sepsis Shock Biomarker |
| Sumario: | Septic shock driven by endotoxemia is associated with high mortality despite advances in supportive care. Polymyxin B hemoperfusion (PMX-HP) selectively removes circulating endotoxin and has shown variable efficacy in randomized trials. While earlier studies, such as EUPHAS, suggested benefit, subsequent trials, including ABDO-MIX and EUPHRATES, yielded neutral results, partly due to heterogeneous patient selection. The recently completed TIGRIS trial addressed these limitations by enrolling septic shock patients with intermediate endotoxin activity (EAA: 0.60-0.89) and high multiple organ dysfunction syndrome (MODS>9) using a Bayesian design. In 151 evaluable patients, PMXHP achieved the primary endpoint, with a 95.3% posterior probability of 28-day survival benefit (adjusted odds ratio [OR]: 0.67; absolute risk reduction [ARR] 6.4%). At 90 days, mortality reduction was greater (ARR: 17.4%; adjusted OR: 0.54;>99% posterior probability of benefit), corresponding to a number needed to treat of 8.1. These results support the targeted use of PMX-HP in a biomarker-defined subgroup and may facilitate broader regulatory approval. |
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