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.
Hurley JC. The Role of Endotoxin in Septic Shock. JAMA. 2019;321(9):902–903. doi:10.1001/jama.2018.20874
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