title: Impact of prothrombin time-International Normalized Ratio on outcome of patients with septic shock receiving polymyxin B cartridge hemoperfusion.
abstract: BACKGROUND
  Although most patients with septic shock have a poor outcome, some may survive after blood purification treatment such as polymyxin B cartridge hemoperfusion (PMX).
  
  
  OBJECTIVE
  To explore the most significant characteristic associated with 28-day mortality in patients with septic shock receiving PMX.
  
  
  METHODS
  Between April 2006 and March 2008, 116 patients with septic shock who had received PMX in a prospectively collected multicenter collaborative study were enrolled. Uni- and multivariate analyses using the Cox proportional hazard model were performed to assess the most significant clinical characteristic that was associated with 28-day mortality.
  
  
  RESULTS
  Among 33 clinicolaboratory characteristics, receiver operating characteristic (ROC) curve analyses selected 12 characteristics with recommended cutoff values such as HCO(3)(-) (≤19.8/>19.8; mEq/L), base excess (≤-5.35/>-5.35; mEq/L), diastolic blood pressure (≤48/>48 mmHg), mean arterial pressure (≤73/>73 mmHg), pH (≤7.29/>7.29), interleukin-6 (≤19,150/>19,150 pg/dL), prothrombin time-International Normalized Ratio (PT-INR; ≤2.05/>2.05), predictive value of Acute Physiology and Chronic Health Evaluation II (APACHE II; ≤0.4/>0.4), pyruvate (≤1.82/>1.82 mg/dL), APACHE II score (≤21/>21), acetate/pyruvate ratio (≤19/>19), and acetate (≤44.8/>44.8 mg/dL) on the basis of large area under the ROC curves for 28-day mortality. The results of uni- and multivariate analyses using these selected characteristics revealed that only PT-INR (≤2.05/>2.05; hazard ratio, 2.823; 95% CI, 1.243-6.412; P = .013) was associated with 28-day mortality. Survival curve analysis demonstrated a significant difference in 28-day mortality between patients with lower (≤2.05) and higher (>2.05) PT-INR (P < .001).
  
  
  CONCLUSIONS
  Prolonged PT-INR is an independent risk factor for 28-day mortality in patients receiving PMX for septic shock.
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan. Electronic address: mm-ishizuka@umin.ac.jp.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ishizuka
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Tago
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006305:Health Status Indicators; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011112:Polymyxin B / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011517:Prothrombin Time; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012308:Risk Management; D012772:Shock, Septic / Q000097:blood / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B