title: Direct hemoperfusion with a polymyxin B column versus vasopressin for gram negative septic shock: a matched cohort study of the effect on survival.
abstract: BACKGROUND
  Vasopressin and direct hemoperfusion with an immobilized polymyxin B column (PMX) have emerged recently as treatments for septic shock. This study assessed the impact of these two treatments on the survival of patients with septic shock.
  
  
  METHODS
  A retrospective, matched cohort study was performed to compare patients who had septic shock and were treated with PMX or vasopressin. The primary endpoint was the 90-day mortality rate. 30 patients receiving PMX were matched to 30 treated with vasopressin.
  
  
  RESULTS
  The 90-day survival rate was significantly higher in the vasopressin group than the PMX group (83% vs. 53%; p = 0.008). In the PMX group, the subgroup with gastrointestinal surgery had a significantly higher survival rate than the subgroup without surgery (76.9% vs. 52.9%; p = 0.01). Cox multivariate analysis showed that vasopressin therapy (versus PMX; HR = 0.27; p < 0.01). The estimated hazard ratio for the SOFA score was 1.44 (p < 0.01), and total pressor dosage an baseline was 1.26 (p = 0.01).
  
  
  CONCLUSIONS
  We found a significant reduction of the mortality rate in septic shock patients who received vasopressin compared with PMX. In the PMX group, the subgroup with gastrointestinal surgery had a significantly higher survival rate than the subgroup without such surgery.
authors.affiliation: Department of Nephrology, Toranomon Hospital, Tokyo, Japan. naokis@toranomon.gr.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.forename: Yoshibumi
authors.initials: Y
authors.lastname: Ubara
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.forename: Rikako
authors.initials: R
authors.lastname: Hiramatsu
authors.forename: Eiko
authors.initials: E
authors.lastname: Hasegawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamanouchi
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Uchida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Wake
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D006464:Hemoperfusion / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D014667:Vasopressins / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D011112:Polymyxin B