title: Analysis of the efficacy of direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) according to the prognostic factors in patients with colorectal perforation.
abstract: OBJECTIVE
  Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) has been reported to improve the outcomes in patients with colorectal perforation. We retrospectively identified prognostic factors in patients with colorectal perforation and considered the efficacy of PMX-DHP based on these prognostic factors.
  
  
  METHODS
  One hundred and fifty-six patients who underwent surgery for colorectal perforation in our department between November 1995 and March 2011 were enrolled in this study. The clinicopathological factors were compared between the survivor and non-survivor groups.
  
  
  RESULTS
  There were 28 patients (17.9 %) who died within 28 days after surgery. According to the multivariate analysis, an Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 17 or more was a significant independent prognostic factor (P = 0.002, odds ratio = 5.39). There was a significant difference in the survival rates between the patients with APACHE II scores of 16 or less and those with scores of 17 or more who had received the PMX-DHP (+) (P < 0.0001).
  
  
  CONCLUSIONS
  The APACHE II score is useful as a prognostic factor in patients with colorectal perforation, and the survival rate was 50 % or lower among the patients with APACHE II scores of 17 or higher. Therefore, PMX-DHP appears to have limited efficacy in serious cases.
authors.affiliation: Department of Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan. ksugimo@juntendo.ac.jp
authors.forename: Kiichi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Sato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maekawa
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Sakurada
authors.forename: Hajime
authors.initials: H
authors.lastname: Orita
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ito
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum; D003106:Colon; D013505:Digestive System Surgical Procedures; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D011379:Prognosis; D012007:Rectum; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D011112:Polymyxin B