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Comment & Response
March 5, 2019

The Role of Endotoxin in Septic Shock

Author Affiliations
  • 1Department of Rural Health, University of Melbourne Medical School, Melbourne, Australia
JAMA. 2019;321(9):902-903. doi:10.1001/jama.2018.20874

To the Editor Dr Dellinger and colleagues1 reported that polymyxin B hemoperfusion was not effective in reducing mortality among patients with septic shock. Among several possible explanations for this negative result, the authors failed to mention the possibility that endotoxin is not the mediator of adverse outcomes in septic shock. They listed 5 pharmacological therapies designed and proven to target endotoxin in preclinical studies but that failed to reduce mortality in at-risk patient populations.