“Impact of timing of polymyxin B‐immobilized fiber column direct hemoperfusion on outcome in patients with septic shock: a single‐center observational study”

Abstract

The effect of polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is controversial. The present study investigates whether outcome in septic shock patients is affected by the time until PMX-DHP initiation and the location of the infection site (intra-or extra-abdominal infection (IAI/EAI)]. Methods: This retrospective observational study included patients receiving PMX-DHP for septic shock but excluded those treated after cardiac surgery or cardiac arrest. Based on the median and/or quartile time from catecholamine treatment to PMX-DHP initiation, the patient cohort was divided into four groups and the IAI and EAI groups into two subgroups. Results: Among the 49 eligible patients, overall 90-day mortality in group 1 (PMX-DHP within 6 h) at 8.3% was significantly lower than in groups 2 (6-9 h; 46.1%), 3 (9-29 h; 58.3%) and 4 (>29 h; 75.0%) (P = 0.021). Multivariate logistic regression analysis showed that the duration from catecholamine treatment to PMX-DHP initiation correlated with 90-day mortality (odds ratio 1.060; 95% confidence interval, 1.004-1.117; P = 0.028). Among the 29 IAI patients, 90-day mortality was significantly lower in the early (within 9 h) than the late group (>9 h) (13.3% versus 64.2%; P = 0.003), but no significant intergroup difference was noted among the 20 EAI patients. Conclusion: Our results suggest that early PMX-DHP initiation (within 9 h after catecholamine treatment) reduces mortality from septic shock, especially in IAI patients.

Lactate predicts the 28‐day survival rate in patients with septic shock treated with the combination of PMX‐DHP and rTM

“…A previous study reported that early PMX‐DHP had better outcomes in patients with intra‐abdominal infection, not in extra‐abdominal infection 12 . However, in our study there was no difference in therapeutic effect of early PMX‐DHP (≤12 hours) between intra‐abdominal (N = 29) and extra‐abdominal (N = 18) infection site (data not shown).…”

“…In the past, there were two reports that the early initiation of PMX‐DHP for septic shock results in better outcomes 11,12 . Tanaka et al reported that early initiation of PMX‐DHP was especially effective in the case of septic shock with intra‐abdominal infection in which presence of hyperendotoxemia was expected 12 .…”

“…Two previous studies 11,12 used the cutoff time of 8 or 6 hours to separate the early and late group. Thus, in sensitivity analysis, we used cutoff time of 8 and 6 hours to divide the early and late group.…”

“…As to the appropriate timing of PMX‐DHP initiation, it is not sufficiently elucidated. Recently, two studies reported that the early initiation of PMX‐DHP for septic shock resulted in better survival rate and these reports set the cutoff time of initiation at 8 11 and 6 hours from catecholamine administration 12 . Despite the fact that the effectiveness of the combination therapy of PMX‐DHP and rTM in patients with septic shock accompanied by DIC has been suggested, 10 these two reports did not mention the adoption or not of rTM therapy.…”

Clinical effects of polymyxin B‐immobilized fiber column direct hemoperfusion for severe bacterial meningitis: A series of 10 cases

“…Thus, starting PMX‐DHP early may be associated with favorable outcome. Indeed, the timing of PMX‐DHP initiation is reported to be an important factor for survival in patients with sepsis . We recommend that PMX‐DHP be performed as soon as possible for bacterial meningitis with impaired consciousness (GCS score < 12).…”