Early recovery in hemodynamics after direct hemoperfusion with polymyxin B-immobilized fibers may predict mortality rate in patients with septic shock.
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.
Kobayashi
Atsuko
A
Department of Emergency and Critical Care Medicine, Okayama University School of Medicine and Hospital, Okayama, Japan. oba_93happy@hotmail.com
Iwasaki
Yasushi
Y
Kimura
Yuichi
Y
Kawagoe
Yoshiaki
Y
Ujike
Yoshihito
Y
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
D000900:Anti-Bacterial Agents; D002395:Catecholamines; D011112:Polymyxin B