Clinical Applications of Polymyxin B Hemadsorption in Sepsis and Septic Shock
Bibliographic record
Abstract
Sepsis and septic shock (SS) represent complex, life-threatening conditions driven by a dysregulated host immune response, leading to multi-organ failure (MOF). The SEPSIS-3 guidelines have emphasized the role of immunology in defining sepsis, but therapies targeting individual mediators have largely failed. Hemoadsorption (HA), particularly with polymyxin B (PMX), presents a promising approach to modulate this immune response by non-specifically removing endotoxins and other mediators, potentially restoring physiological homeostasis. This review explores the use of PMX hemoperfusion (PMX-HA) over the last 20 years in critically ill patients, examining its role in sepsis, particularly in endotoxemic septic shock. PMX-HA works by targeting endotoxin removal, reducing inflammatory mediators, and modulating immune cell activity, including neutrophil and monocyte function. However, treatment success varies due to patient heterogeneity. Identifying optimal target populations, based on markers like endotoxin activity (EAA), SOFA scores, and lactate levels, is critical for determining the timing, dose, and duration of PMX-HA therapy. Recent studies have highlighted the importance of stratifying patients by severity and endotoxin burden, suggesting that PMX-HA is most beneficial for patients with high endotoxin activity and severe organ dysfunction. Additionally, prolonged PMX-HA sessions may improve outcomes in patients with sustained endotoxin levels. This review emphasizes the need for a personalized approach to PMX-HA, with tailored treatment protocols to optimize clinical outcomes in sepsis and septic shock patients. Future research should focus on refining patient selection criteria and determining the most effective treatment regimens.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".