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

Yoshihiko Nakamura,Yasumasa Kawano,Hiroyasu Ishikura,Kota Hoshino,Fumiaki Kiyomi,Mariko Mizunuma,Reiko Yamasaki,Takeshi Nishida,Mineji Hayakawa,Taisuke Kitamura

doi:10.1186/s13054-017-1712-3

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.

Highlights

The purpose of this study was to investigate whether polymyxin B hemoperfusion (PMX-HP) improves the survival of patients with septic shock
Study design, setting, and selection of participants This retrospective, observational study used the dataset of the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC disseminated intravascular coagulation (DIC)) study, which was conducted in 42 intensive care unit (ICU) in 40 institutions in Japan (Additional files 1 and 2) and was approved by the Institutional Review Boards of all participating hospitals
We defined the ICU policy as follows: open ICU was defined as all patients admitted to the ICU were managed by each department of doctors; closed ICU was defined as all patients admitted to the ICU were managed by intensivists or anesthesiologists or emergency doctors

Summary

Introduction

The purpose of this study was to investigate whether polymyxin B hemoperfusion (PMX-HP) improves the survival of patients with septic shock. Yamato et al [10] reported that treatment with a combination of PMX-HP and recombinant human soluble thrombomodulin (rhsTM) significantly improves survival rates after septic shock with disseminated intravascular coagulation (DIC) due to GPC or GNR infections. These results suggest that PMX-HP has a survival benefit in patients with GNR infections, and in those with GPC-induced events. In the ABDOMIX RCT [12] there was no significant difference in the 28-day mortality rate between PMX-HP and conventional treatment (27.7% vs 19.5%, respectively; P = 0.14) It remains unclear whether PMX-HP produces a survival benefit in patients with abdominal septic shock.

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