Critical care explorations · 2025
Polymyxin B Hemoperfusion for Patients With Septic Shock Requiring High-Dose Norepinephrine: A Multicenter Prospective Cohort Study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Kawazoe Yu, Miyamoto Kyohei, Miyagawa Noriko, Ohta Yoshinori, Yamamura Hitoshi, Kimura Takuya, Toyoda Yukitoshi, Kyo Michihito, Sato Tetsuya, Kinjo Masashi, Takahashi Masaki, Maruyama Junichi, Fukushima Kazunori, Matsuura Hiroshi, Murata Satoru, Okazaki Tomoya, Sakurai Toshihiro, Suzuki Tsuyoshi, Hanajima Tasuku, Takahashi Gaku, Morimoto Takeshi
Аннотация
IMPORTANCE: Polymyxin B hemoperfusion (PMX-HP) is a potential therapeutic option for sepsis; however, its clinical effects remain unclear.
OBJECTIVE: We explored the association between PMX-HP and clinical outcomes in patients in ICUs.
DESIGN, SETTING, AND PARTICIPANTS: This is a multicenter prospective cohort study conducted in 20 ICUs in Japan between 2020 and 2022. Patients with septic shock requiring high-dose norepinephrine (≥ 0.2 µg/kg/min) were included.
MAIN OUTCOMES AND MEASURES: We compared patient characteristics and outcomes between those who received PMX-HP (PMX group) and those who did not (non-PMX group). A primary outcome was 28-day mortality, with secondary outcomes including changes in mean arterial pressure (MAP) and vasoactive-inotropic score over time in the initial 48 hours, 28-day vasopressor-free days, and 90-day mortality rate.
RESULTS: Among 309 patients, 175 (56.6%) were males, with a median age of 72 years and an Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 26. Overall, 82 patients underwent PMX-HP. The PMX and non-PMX groups had similar median ages (71 vs. 73 yr) and APACHE II scores (26 vs. 27). The median PMX-HP duration was 1016 minutes. The 28-day mortality was similar between the groups (PMX group: 17.1%, non-PMX group: 18.9%, p = 0.71), with an adjusted hazard ratio of 0.88 (95% CI, 0.46-1.68). MAP was maintained at a higher level with low-dose vasopressor from 8 to 32 hours following admission in the PMX group. The PMX group had fewer 28-day ICU-free days (16 vs. 18, p = 0.026). The 90-day mortality rate was similar between the groups (PMX group, 23.5%; non-PMX group, 27.1%; p = 0.62).
CONCLUSIONS AND RELEVANCE: PMX-HP was not associated with the 28-day mortality improvement but was associated with higher MAP and lower vasopressor use for 8-32 hours of admission. Our findings suggested that PMX-HP requires careful adaptation.
OBJECTIVE: We explored the association between PMX-HP and clinical outcomes in patients in ICUs.
DESIGN, SETTING, AND PARTICIPANTS: This is a multicenter prospective cohort study conducted in 20 ICUs in Japan between 2020 and 2022. Patients with septic shock requiring high-dose norepinephrine (≥ 0.2 µg/kg/min) were included.
MAIN OUTCOMES AND MEASURES: We compared patient characteristics and outcomes between those who received PMX-HP (PMX group) and those who did not (non-PMX group). A primary outcome was 28-day mortality, with secondary outcomes including changes in mean arterial pressure (MAP) and vasoactive-inotropic score over time in the initial 48 hours, 28-day vasopressor-free days, and 90-day mortality rate.
RESULTS: Among 309 patients, 175 (56.6%) were males, with a median age of 72 years and an Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 26. Overall, 82 patients underwent PMX-HP. The PMX and non-PMX groups had similar median ages (71 vs. 73 yr) and APACHE II scores (26 vs. 27). The median PMX-HP duration was 1016 minutes. The 28-day mortality was similar between the groups (PMX group: 17.1%, non-PMX group: 18.9%, p = 0.71), with an adjusted hazard ratio of 0.88 (95% CI, 0.46-1.68). MAP was maintained at a higher level with low-dose vasopressor from 8 to 32 hours following admission in the PMX group. The PMX group had fewer 28-day ICU-free days (16 vs. 18, p = 0.026). The 90-day mortality rate was similar between the groups (PMX group, 23.5%; non-PMX group, 27.1%; p = 0.62).
CONCLUSIONS AND RELEVANCE: PMX-HP was not associated with the 28-day mortality improvement but was associated with higher MAP and lower vasopressor use for 8-32 hours of admission. Our findings suggested that PMX-HP requires careful adaptation.