Introduction: Septic shock remains a major cause of mortality among critically ill patients, often driven by an exaggerated inflammatory response to endotoxins. Polymyxin B hemoperfusion (PMX-HP) is an extracorporeal therapy designed to remove circulating endotoxins and attenuate immune-mediated damage. While PMX-HP has shown clinical promise, the optimal timing for its initiation remains uncertain. Emerging evidence suggests that earlier intervention, within hours of shock onset, may improve outcomes. This meta-analysis evaluates whether initiating PMX-HP within 3 to 12 hours of septic shock onset reduces mortality and improves clinical markers compared to delayed treatment. Methods: A systematic literature review was conducted for studies published from 2012 through 2025 evaluating PMX-HP timing in adult septic shock patients. Six studies comparing early (3–12 hours) versus delayed initiation of PMX-HP were included. Primary outcomes were 28-day or in-hospital mortality. Secondary outcomes included PaO2/FiO2 (P/F) ratios and changes in Sequential Organ Failure Assessment (SOFA) scores. A random-effects meta-analysis model was used to pool data. Subgroup analyses assessed the influence of infection source and illness severity. Results: Six studies with 363 patients from Asian centers were analyzed: 171 received PMX-HP early and 192 received it later. Mean ages were 64.7 (early) and 67.5 (delayed), with similar baseline APACHE II scores (~51). Intra-abdominal infections predominated, followed by malignancy-associated sepsis. Early PMX-HP was associated with a statistically significant reduction in mortality and higher post-treatment P/F ratios. Additionally, early-treated patients had more rapid declines in SOFA scores, indicating faster organ function recovery. Moderate heterogeneity was observed due to variations in patient profiles and study design. Conclusions: Early initiation of PMX-HP (within 3–12 hours of septic shock onset) significantly reduces mortality, improves oxygenation, and accelerates organ recovery compared to delayed initiation. These benefits appear especially pronounced in intra-abdominal and malignancy-related sepsis. Further prospective studies are needed to optimize patient selection and define standardized timing protocols for PMX-HP in septic shock.
Jagra et al. (Sun,) studied this question.