Ultra-Long Polymyxin B Hemoperfusion and Its Effect on Vasopressor Dosage and Organ Dysfunction in Patients With Septic Shock Requiring High-Dose Norepinephrine: A Post Hoc Analysis of a Prospective Cohort Study.

BACKGROUND

Prolonged duration of polymyxin B hemoperfusion (PMX-HP) for septic shock is not widely investigated.

METHODS

We used BEAT-SHOCK, a prospective registry including 309 adult patients with septic shock requiring high-dose norepinephrine (≥ 0.2 μg/kg/min). Our post hoc analysis included 82 patients that underwent PMX-HP, dichotomized into either the ultra-long PMX-HP group (first session duration ≥ 12 h; n = 53) or the non-ultra-long PMX-HP group (< 12 h; n = 29). The primary outcomes were changes in vasopressor/inotrope dosage, represented by vasoactive-inotropic score (VIS), and sequential organ failure assessment (SOFA) score from baseline to day 3.

RESULTS

The median durations of the first PMX-HP session in the ultra-long and non-ultra-long PMX-HP groups were 1290 and 358 min, respectively. Their median baseline VIS was 38.3 (IQR 26.0-49.5) in the ultra-long group, 38.1 (IQR 30.9-55.6) in the non-ultra-long PMX-HP group. The median baseline SOFA score was 11 (IQR 9-13) in both groups. The changes in these scores from baseline to day 3 did not differ between them (adjusted difference -3.8 [95% confidence interval -9.0 to 11.3] for VIS and -0.0 [95% confidence interval -1.5 to 1.5] for SOFA score). The 90-day mortality rate was 24.7% in the ultra-long PMX-HP group and 21.1% in the non-ultra-long PMX-HP group (adjusted hazard ratio 1.35; 95% confidence interval 0.49-3.69).

CONCLUSIONS

Ultra-prolonged PMX-HP for ≥ 12 h was not associated with a greater reduction in vasopressor/inotrope dosage or improvement in organ dysfunction on day 3 than PMX-HP < 12 h in our patients with septic shock without endotoxin monitoring.

TRIAL REGISTRATION: UMIN Clinical Trial Registry on 1 November 2019 (registration no. UMIN000038302).