Mortality Risk Prediction in Abdominal Septic Shock Treated with Polymyxin-B Hemoperfusion: A Retrospective Cohort Study

García-Ramos, Sergio; Caamaño, Estrela; Benítez, Patrocinio Rodríguez; Benito, Pilar; Calvo, Alberto José Gutiérrez; Ramos, Silvia; Power, Mercedes; Garutti, Ignacio; Piñeiro, Patricia

doi:10.3390/jpm13071023

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…Blood purification treatments, such as PMX-HP or AN69-oXiris, can remove endotoxins and excess cytokines to improve systemic dysregulation and hemodynamic instability. Garcia-Ramos et al showed that PMX-HP treatment reduced mortality in postoperative patients with abdominal septic shock to 25%, significantly lower than the 57.98% predicted by APACHE II scores ( 26 ). Zang et al also reported that using AN69-oXiris for septic patients in the surgical ICU was associated with improved hemodynamic status and decreased cytokine levels ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP

Kim,

Chung,

Lee

et al. 2024

Front. Med.

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PurposeIn septic shock patients, pathogens and excessive endotoxins continuously overstimulate the host’s immune system with a cytokine storm that can lead to multi-organ failure and even mortality. Various types of extracorporeal blood purification treatments have recently been introduced to remove excessive endotoxins and cytokines. Herein, we compared the clinical efficacy of two blood purification methods, PMX-HP and AN69-oXiris, and discussed their detailed indications according to disease severity.Materials and methodsFrom December 2016 to April 2023, patients who underwent emergent surgery due to septic shock secondary to peritonitis and subsequently received blood purification treatment with AN69-oXiris or PMX-HP were enrolled. Propensity score (PS)-matching was conducted to adjust for baseline characteristics between the two groups, and the changes in clinical parameters and outcomes were compared. Clinical outcomes were assessed in subgroups of patients who underwent PMX-HP treatment divided according to SOFA scores into low (0–7), intermediate (8–13), and high (> 13) disease severity groups.ResultsForty patients received blood purification therapy with either PMX-HP or AN69-oXiris during the study period. After 1:2 PS matching, six patients in the AN69-oXiris group and 12 patients in the PMX-HP group were finally analyzed. Vasoactive-inotropic scores (VISs) decreased in both groups after 48 h of treatment compared to the baseline values, but the change in VISs was more pronounced in the PMX-HP group {−57.6 [interquartile range (IQR) = −166.4 – (−10)] vs. -22.9 [IQR = −64–0], respectively, p = 0.041}. Decreases in cardiovascular SOFA scores were significantly pronounced in the PMX-HP group [−1.5 (IQR = −4 – 0) vs. 0 (IQR = −1 – 1), respectively, p = 0.035]. The 7-day mortality rate was significantly lower than the predicted mortality rate in a subgroup analysis of patients treated with PMX-HP in both the low disease severity group and the intermediate disease severity group.ConclusionPMX-HP and AN69-oXiris could be therapeutic options for refractory septic shock patients with intra-abdominal origins, especially after the surgical elimination of the infectious sources. A tailored modality choice that takes into account patient characteristics, such as disease severity and cost burden, could optimize the efficacy of this strategy.

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Section: Discussionmentioning

confidence: 99%

The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP

Kim,

Chung,

Lee

et al. 2024

Front. Med.

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“…The results from the EUPHRATES trial added two new dimensions to patient selection for endotoxin removal. First, as seen with subsequent studies [28,29] severity of organ failure is a determinant of patient response. Second, the burden of endotoxin may be too high for some patients to benefit.…”

Section: Adsorptive Capacity Of the Pmx Cartridge And The Tigris Trialmentioning

confidence: 97%

“…Manifestations of endotoxic septic shock such as coagulopathy and hyperlactatemia may help identify patients with lethal endotoxemia [27]. A sequential organ failure assessment (SOFA) score > 7 appears to delineate a high risk of death in patients considered for anti-endotoxin therapy [28,29].…”

Section: Patient Identification For Anti-endotoxin Therapy: Past and ...mentioning

confidence: 99%

Endotoxic Septic Shock: Diagnosis and Treatment

Foster,

Kellum

2023

IJMS

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Endotoxin, also referred to as lipopolysaccharide (LPS), is a potent stimulator of the inflammatory cascade which may progress to sepsis and septic shock. The term endotoxic septic shock has been used for patients who have a clinical phenotype that is characterized by high endotoxin activity in addition to a high burden of organ failure; especially a pattern of organ failure including hepatic dysfunction, acute kidney injury, and various forms of endothelial dysfunction. Endotoxic septic shock has been a target for drug therapy for decades with no success. A likely barrier to their success was the inability to quantify endotoxin in the bloodstream. The Endotoxin Activity Assay (EAA) is positioned to change this landscape. In addition, medical devices using adsorptive technology in an extra-corporeal circulation has been shown to remove large quantities of endotoxin from the bloodstream. Focusing on the use of EAA to determine high concentrations of endotoxin will allow patients with endotoxic septic shock to be identified quickly and these patients may benefit most from removal of endotoxin using extracorporeal methods.

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Current perspectives in the management of sepsis and septic shock

Chiscano-Camón,

Ruiz-Sanmartin,

Bajaña

et al. 2024

Front. Med.

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Within patients with sepsis, there exists significant heterogeneity, and while all patients should receive conventional therapy, there are subgroups of patients who may benefit from specific therapies, often referred to as rescue therapies. Therefore, the identification of these specific patient subgroups is crucial and lays the groundwork for the application of precision medicine based on the development of targeted interventions. Over the years, efforts have been made to categorize sepsis into different subtypes based on clinical characteristics, biomarkers, or underlying mechanisms. For example, sepsis can be stratified into different phenotypes based on the predominant dysregulated host response. These phenotypes can range from hyperinflammatory states to immunosuppressive states and even mixed phenotypes. Each phenotype may require different therapeutic approaches to improve patient outcomes. Rescue strategies for septic shock may encompass various interventions, such as immunomodulatory therapies, extracorporeal support (e.g., ECMO), or therapies targeted at specific molecular or cellular pathways involved in the pathophysiology of sepsis. In recent years, there has been growing interest in precision medicine approaches to sepsis and phenotype identification. Precision medicine aims to tailor treatments to each individual patient based on their unique characteristics and disease mechanisms.

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Mortality Risk Prediction in Abdominal Septic Shock Treated with Polymyxin-B Hemoperfusion: A Retrospective Cohort Study

Cited by 3 publications

References 26 publications

The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP

The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP

Endotoxic Septic Shock: Diagnosis and Treatment

Current perspectives in the management of sepsis and septic shock

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