Potential survival benefit of polymyxin B hemoperfusion in patients with septic shock: a propensity-matched cohort study

Abstract

BackgroundThe purpose of this study was to investigate whether polymyxin B hemoperfusion (PMX-HP) improves the survival of patients with septic shock.MethodsThis was a retrospective, multicenter study conducted on patients treated during a 3-year period. We performed propensity-score analyses of the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study database. The study included data on 1723 patients with septic shock aged 16 years or older. Furthermore, we divided patients into to PMX-HP- and non-PMX-HP-treated groups. The primary endpoint was all-cause hospital mortality; secondary endpoints included intensive care unit (ICU) mortality and number of ICU-free days (ICUFDs) in the first 28 days.ResultsOf 1,723 eligible patients, 522 had received PMX-HP. Propensity score matching created 262 matched pairs (i.e., 262 patients in each of the non-PMX-HP and PMX-HP groups). The proportion of all-cause hospital mortality was significantly lower in the PMX-HP group than in the non-PMX-HP group (32.8% vs. 41.2%; odds ratio (OR): 0.681; 95% confidence interval (CI): 0.470–0.987; P = 0.042). The number of ICUFD in the first 28 days was significantly higher in the PMX-HP group than in the non-PMX-HP group (18 (0-22) vs. 14 (0-22) days, respectively; P = 0.045). On the other hand, there was no significant difference in ICU mortality between the two groups (21.8% vs. 24.4%; OR: 0.844; CI: 0.548–1.300; P = 0.443).ConclusionsOur results strongly suggest that PMX-HP reduces all-cause hospital mortality and length of ICU stay in patients with septic shock.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1712-3) contains supplementary material, which is available to authorized users.

Successful treatment of direct hemoperfusion with polymyxin B-immobilized fiber for septic shock and severe acute kidney injury due to ceftriaxone-resistant Escherichia coli: a case report with literature review

“…In this case, the second PMX was performed the next day because the hemodynamics of the patient did not fully improve after the first treatment. PMX reduces all-cause hospital mortality and length of ICU stay in patients with septic shock [10]. Contrary to this, the risk ratio of a 28-day mortality associated with PMX was 1.03 [27].…”

“…It has been reported that PMX-DHP should be performed as soon as possible in septic shock [7]. However, the efficacy of PMX-DHP in septic shock is still controversial [8][9][10].…”

Prescription of CRRT: a pathway to optimize therapy

“…Recent studies using different types of membrane adsorbers of endotoxin and cytokines have shown some promising results (Table 1). Some clinical improvement was reported in selected studies involving septic patients treated with hemoperfusion devices comprised polymyxin B-bound fibers designed to adsorb endotoxin [74][75][76][77][78][79]. However, other studies showed no difference in clinical endpoints between polymyxin B plus conventional therapy and conventional therapy alone [80][81][82][83].…”

Polymyxin B hemoperfusion in septic shock: nothing overmuch (Meden Agan)!

“…As the study of Nakamura et al was not initially designed to evaluate PMX-HP treatment effect, significant variables are missing, such as number and duration of PMX sessions, time of administration, and possible adverse events (10). PMX-HP has been used as rescue therapy in patients unresponsive to a goal-directed protocol or with catecholamine-resistant septic shock.…”

“…Careful identification of the candidate patients is of most importance for the success of this blood purification technique, as it seems that highly endotoxemic septic shock patients may benefit from PMX-HP treatment. Recently, Nakamura et al suggested that PMX-HP improves outcome by reducing all-cause hospital mortality and the length of ICU stay in patients with a variety of infections causing septic shock types induced by not only GNR but also GPC and other microorganisms (10). Smart randomized studies in distinct homogenous populations of septic patients using strict criteria, including endotoxin measurements, are urgently needed to confirm or refute these results.…”