Background
sepsis, organ failure, gram-negative, septic shock
MULTIPLE ORGAN FAILURE, SEPSIS, SEPTIC SHOCK
Endotoxin, a part of the outer membrane of gram-negative bacteria, can trigger both a host immune response and multiple organ failure. Higher endotoxin activity is associated with greater degrees of organ failure and higher mortality in sepsis [The EUPHRATES trial, another RCT using PMX-HA, enrolled only patients with septic shock and higher levels of endotoxin activity (Endotoxin Assay Activity [EAA] ≥ 0.60), who were considered potential responders of PMX-HA, but failed to show a significant reduction in 28-day mortality [In this context, we sought to identify previously unidentified patient subgroups with sepsis who may benefit from targeted therapy using PMX-HA. For this study, the derived criteria for targeted use of PMX-HA were determined with the machine learning-based causal forest model in an observational cohort (the JSEPTIC-DIC cohort) and validated in an RCT cohort (the EUPHRATES trial cohort).