Effects of Polymyxin B Hemoperfusion on Septic Shock Patients Requiring Noradrenaline: Analysis of a Nationwide Administrative Database in Japan

Abstract

<b><i>Introduction:</i></b> Polymyxin B hemoperfusion (PMX) reduces endotoxin in septic shock patients’ blood and can improve hemodynamics and organ functions. However, its effects on the reduction of septic shock mortality are controversial. <b><i>Methods:</i></b> Using the Japanese diagnosis procedure combination database from April 2016 to March 2019, we identified adult septic shock patients treated with noradrenaline. This study used propensity score matching to compare the outcome between PMX-treated and non-treated patients. The primary endpoint was 28-day mortality, counting from the day of noradrenaline initiation. The secondary endpoints were noradrenaline-, ventilator-, and continuous hemodiafiltration (CHDF)-free days at day 28. <b><i>Results:</i></b> Of 30,731 eligible patients, 4,766 received PMX. Propensity score matching produced a matched cohort of 4,141 pairs with well-balanced patient backgrounds. The 28-day survival rate was 77.9% in the PMX group and 71.1% in the control group (<i>p</i> < 0.0001). Median days of noradrenalin-, CHDF-, and ventilator-free days were 2 days (<i>p</i> < 0.0001), 2 days (<i>p</i> < 0.0001), and 6 days (<i>p</i> < 0.0001) longer in the PMX group than in the control group, respectively. When stratified with the maximum daily dose of noradrenaline, the PMX group showed a statistically significant survival benefit in the groups with noradrenaline dose <20 mg/day but not in the noradrenaline group dose ≥20 mg/day. <b><i>Conclusion:</i></b> Analysis of large Japanese databases showed that septic shock patients who received noradrenaline might benefit from PMX treatment.

Effectiveness of polymyxin B hemoperfusion for sepsis depends on the baseline SOFA score: a nationwide observational study

“…Conversely, in a study on septic shock with AKI who required CRRT, the 28-day mortality rates with and without PMX were 40.2% and 46.7%, respectively, with a significant improvement with PMX treatment [ 15 ]. Our recent study on noradrenaline-treated septic shock patients showed a substantial improvement of 28-day survival rates by PMX treatment, 77.9% for the PMX group and 71.1% for the non-PMX group [ 16 ]. In addition, our analysis of data from patients with sepsis requiring CHDF showed that PMX significantly improved mortality and shortened hospital and ICU stays [ 17 ].…”

“…Our previous study on the analysis of noradrenaline-administered septic shock patients showed that PMX efficacy is less pronounced in the subgroup of patients with the highest maximum daily dose of noradrenaline [ 16 ]. Furthermore, several reports indicate that PMX treatment is more effective when the time between the onset of shock and the administration of PMX is shorter [ 21 , 22 ].…”

Effects of polymyxin B hemoperfusion in patients with sepsis requiring continuous hemodiafiltration: Analysis of a nationwide administrative database in Japan

“…We also recently used the DPC data to examine the efficacy of PMX in patients with septic shock requiring noradrenaline administration. The data showed that PMX provides significant clinical benefits, including a statistically significant improvement in survival rate and a reduction in ventilator use duration [12]. In the current study, we focused on more severely ill sepsis patients who used CHDF, and we found PMX is useful in this group of patients.…”

Effectiveness of polymyxin B hemoperfusion for sepsis depends on the baseline SOFA score: a nationwide observational study

“…Conversely, in a study on septic shock with AKI who required CRRT, the 28 day-mortality rates with and without PMX were 40.2% and 46.7%, respectively, with a signi cant improvement with PMX treatment [10]. Our recent study on noradrenaline-treated septic shock patients showed a substantial improvement of 28 day-survival rates by PMX treatment, 77.9% for the PMX group and 71.1% for the non-PMX group [11]. In addition, our analysis of data from patients with sepsis requiring CHDF showed that PMX signi cantly improved mortality and shortened hospital and ICU stays [12].…”

“…Our previous study on the analysis of noradrenaline-administered septic shock patients showed that PMX e cacy is less pronounced in the subgroup of patients with the highest maximum daily dose of noradrenaline [11]. Furthermore, several reports indicate that PMX treatment is more effective when the time between the onset of shock and the administration of PMX is shorter [16,17].…”