Abstract
BackgroundDirect hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) has been widely used for patients with septic shock around the world, but the prognostic factors have not been fully understood. We conducted a retrospective analysis to determine the prognostic factors in patients with septic shock who underwent PMX-DHP.MethodsTwenty-nine patients with septic shock who underwent PMX-DHP were included in the study. The patients were divided into groups based on survival (n = 23) and non-survival (n = 6) 28 days after PMX-DHP, and the clinical data for the two groups before and after PMX-DHP were compared.ResultsIn non-survivors, the vasopressor dependency index before PMX-DHP was significantly higher (p = 0.046), and the leukocyte count before PMX-DHP was significantly lower (p = 0.024) than in survivors. Furthermore, base excess after PMX-DHP was significantly lower in non-survivors (p = 0.007) than in survivors. The optimal cutoff points of the vasopressor dependency index, leukocyte count, and base excess identified by receiver operating characteristic curves were 0.499/mmHg, 1360/μL, and −6.4 mmol/L, respectively. And the score using these three cutoffs, termed the prognostic score, was related to the prognosis of septic shock patients who underwent PMX-DHP (area under the curve = 0.946).ConclusionsThe prognostic score, using three parameters which are immediately and readily available in early phase after starting PMX-DHP, might be useful to predict the prognosis of these patients.
Highlights
Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) has been widely used for patients with septic shock around the world, but the prognostic factors have not been fully understood
Comparison of the clinical features and laboratory data before Polymyxin B-immobilized fiber (PMX)-DHP between survivors and non-survivors In non-survivors, the vasopressor dependency index (VDI) before PMX-DHP was significantly higher (p = 0.046) and the leukocyte count before PMX-DHP was significantly lower (p = 0.024) than in survivors (Tables 3 and 4)
The findings of this retrospective study suggest that the VDI and leukocyte count before PMX-DHP and base excess (BE) after PMX-DHP may be prognostic factors, and the total score calculated with cutoff points for these factors could be related to the survival rate of patients with septic shock who undergo PMX-DHP
Summary
Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) has been widely used for patients with septic shock around the world, but the prognostic factors have not been fully understood. We conducted a retrospective analysis to determine the prognostic factors in patients with septic shock who underwent PMX-DHP. Intra-abdominal infection is a main focus of severe sepsis and septic shock [5], and a crucial problem in surgical critical care. PMX is believed to mainly adsorb endotoxin, but Matsukuma et al Journal of Intensive Care (2015) 3:13 recent studies have reported that it adsorbs anandamide, inducing hypotension, immunosuppression, and cytotoxicity [9], and reduces serum cytokine levels [10,11], monocyte messenger RNA expression [12], and the percentage of CD4+ CD25+ Forkhead box protein 3 (Foxp3)+ T cells, termed regulatory T cells in the CD4+ T cell population [13]
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