Polymyxin B Hemoperfusion and Mortality in Abdominal Septic Shock
- Jean-Louis Vincent, MD, PhD jlvincen@ulb.ac.beDepartment of Intensive CareUniversité Libre de BruxellesBrussels, Belgium
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- ABDOMEN
- CRITICAL CARE
- DATA INTERPRETATION, STATISTICAL
- DRUG THERAPY
- ENDOTOXINS
- HEMOPERFUSION
- POLYMYXIN B
- SEPSIS
- SHOCK, SEPTIC
To the Editor: In their randomized controlled trial, Dr Cruz and colleagues1 reported that polymyxin B hemoperfusion reduced 28-day mortality in patients with severe sepsis or septic shock. I believe that this conclusion is wrong. The statistically significant difference in mortality rates reported in this study was based on the analysis of a hazard ratio generated by a Cox proportional hazards regression survival model. However, the odds ratio (OR) of the crude 28-day mortality rates did not reach statistical significance (11/34 vs 16/30; OR, 0.42; 95% confidence interval [CI], 0.13-1.29; P = .13). Such a difference between the hazard ratio and the OR can only be explained by a later occurrence of deaths in the treated group, an effect that is suggested in Figure 3.1 This observation is concerning in an unblinded trial, in which investigators could forgo life support later in patients in the treatment group, creating a …
