title: Exacerbation of prothrombin time-international normalized ratio before second polymyxin B cartridge hemoperfusion predicts poor outcome of patients with severe sepsis and/or septic shock.
abstract: BACKGROUND
  Although polymyxin B cartridge hemoperfusion (PMX) has an important place in the treatment of patients with severe sepsis and/or septic shock (SS), there are few rigid indications for performing PMX a second time.The objective of the study was to investigate the clinicolaboratory characteristics (CCs) showing the most significant change from the first to the second PMX and associated with 28-d mortality in patients with SS.
  
  
  METHODS
  Between April 2006 and March 2008, 78 patients with SS who had received two sessions of PMX in a prospectively collected multicenter collaboration study were enrolled. Univariate and multivariate analyses using the differences in the values of individual CCs (Δ-CCs) were performed to assess the CCs showing the most significant change in value associated with 28-d mortality. The Δ-CC was defined as: Δ2nd-1st-CC = value of the CC just before the second PMX - value of the CC just before the first PMX.
  
  
  RESULTS
  Among 28 Δ2nd-1st-CCs, 10 Δ2nd-1st-CCs were selected by using receiver operating characteristic (ROC) curve analyses. The results of multivariate analysis using adequate 8 Δ2nd-1st-CCs that had been selected by univariate analyses revealed that only Δ2nd-1st-prothrombin time-international normalized ratio (PT-INR) (≤0.16/>0.16; hazard ratio = 6.562; 95% CI = 1.525-28.23; P = 0.012) was associated with 28-d mortality. Survival curve analysis demonstrated a significant difference in 28-d mortality between patients with a lower (≤0.16) and a higher (>0.16) Δ2nd-1st-PT-INR (P < 0.001).
  
  
  CONCLUSIONS
  Patients with exacerbation of PT-INR (>0.16) after initial PMX are unlikely to benefit clinically from a second PMX for treatment of SS.
authors: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan. Electronic address: mm-ishizuka@umin.ac.jp.
authors: Mitsuru
authors: M
authors: Ishizuka
authors: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors: Azusa
authors: A
authors: Terasaki
authors: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors: Keiichi
authors: K
authors: Kubota
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000066491:Clinical Decision-Making; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D011517:Prothrombin Time; D012372:ROC Curve; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B
keywords: 28-day mortality; Disseminated intravascular coagulation; Polymyxin B cartridge hemoperfusion; Prothrombin time-international normalized ratio; Severe sepsis and/or septic shock