title: Early recovery in hemodynamics after direct hemoperfusion with polymyxin B-immobilized fibers may predict mortality rate in patients with septic shock.
abstract: OBJECTIVE
  This retrospective and observational study attempted to determine whether the rapid improvement in hemodynamic parameters and the subsequent discontinuation or decrease of catecholamine infusion shortly after direct hemoperfusion with polymyxin B-immobilized fibers (PMX) may be strong predictors of mortality in patients with septic shock.
  
  
  METHODS
  Retrospectively, 46 patients were divided into two groups; those who survived more than 30 days after PMX (survival group, S group) and those who died within 30 days (nonsurvival group, NS group). Sequential Organ Failure Assessment (SOFA) scores, mean arterial pressure, catecholamine index (CAI), and vasopressor dependency index (VDI) were examined before and after PMX. The same parameters were examined on days 3, 4, 5, 6, 8, and 16 after PMX.
  
  
  RESULTS
  CAI in the S group significantly decreased from 14.7 (95% CI, 10.3-19.1) at baseline to 6.4 (95% CI, 3.7-9.2; P < 0.001) at post-PMX, whereas a significant decrease in CAI was not observed in the NS group (23.1; 95% CI, 15.4-30.7 to 18.1; 95% CI, 11.6-24.7; P = 0.114). The significant decrease in VDI at post-PMX was observed both in the S group and in the NS group. If the cutoff point of VDI at post-PMX is 0.2, there is a significant difference in numbers of the S group (VDI ≥ 0.2, n = 24; VDI < 0.2, n = 2) and NS group (VDI ≥ 0.2, n = 8; VDI < 0.2, n = 20) using Fisher's exact test.
  
  
  CONCLUSIONS
  We concluded that the early improvement in CAI and VDI shortly after PMX might be prognostic indicators for survival.
authors.affiliation: Department of Emergency and Critical Care Medicine, Okayama University School of Medicine and Hospital, Okayama, Japan. oba_93happy@hotmail.com
authors.forename: Atsuko
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kimura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kawagoe
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Ujike
mesh_terms: D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects; D002395:Catecholamines / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006464:Hemoperfusion; D006801:Humans; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011112:Polymyxin B / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012129:Respiratory Function Tests; D012772:Shock, Septic / Q000382:microbiology / Q000401:mortality*; D013534:Survival
chemical_list: D000900:Anti-Bacterial Agents; D002395:Catecholamines; D011112:Polymyxin B