Prognostic factors in patients with septic shock in digestive surgery who have undergone direct hemoperfusion with polymyxin B-immobilized fibers: a retrospective observational study.
BACKGROUND
Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) has been widely used for patients with septic shock around the world, but the prognostic factors have not been fully understood. We conducted a retrospective analysis to determine the prognostic factors in patients with septic shock who underwent PMX-DHP.


METHODS
Twenty-nine patients with septic shock who underwent PMX-DHP were included in the study. The patients were divided into groups based on survival (n = 23) and non-survival (n = 6) 28 days after PMX-DHP, and the clinical data for the two groups before and after PMX-DHP were compared.


RESULTS
In non-survivors, the vasopressor dependency index before PMX-DHP was significantly higher (p = 0.046), and the leukocyte count before PMX-DHP was significantly lower (p = 0.024) than in survivors. Furthermore, base excess after PMX-DHP was significantly lower in non-survivors (p = 0.007) than in survivors. The optimal cutoff points of the vasopressor dependency index, leukocyte count, and base excess identified by receiver operating characteristic curves were 0.499/mmHg, 1360/μL, and -6.4 mmol/L, respectively. And the score using these three cutoffs, termed the prognostic score, was related to the prognosis of septic shock patients who underwent PMX-DHP (area under the curve = 0.946).


CONCLUSIONS
The prognostic score, using three parameters which are immediately and readily available in early phase after starting PMX-DHP, might be useful to predict the prognosis of these patients.
Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, Minami-Kogushi 1-1-1, Ube City, Yamaguchi Prefecture Japan.
Satoshi
S
Matsukuma
Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, Minami-Kogushi 1-1-1, Ube City, Yamaguchi Prefecture Japan.
Kazuhiko
K
Sakamoto
Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, Minami-Kogushi 1-1-1, Ube City, Yamaguchi Prefecture Japan.
Mitsuo
M
Nishiyama
Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, Minami-Kogushi 1-1-1, Ube City, Yamaguchi Prefecture Japan.
Takao
T
Tamesa
Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, Minami-Kogushi 1-1-1, Ube City, Yamaguchi Prefecture Japan.
Shigefumi
S
Yoshino
Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, Minami-Kogushi 1-1-1, Ube City, Yamaguchi Prefecture Japan.
Shoichi
S
Hazama
Intensive Care Unit, Yamaguchi University Hospital, Ube City, Yamaguchi Prefecture Japan.
Rumi
R
Oshibuchi
Intensive Care Unit, Yamaguchi University Hospital, Ube City, Yamaguchi Prefecture Japan.
Norimasa
N
Matsuda
Intensive Care Unit, Yamaguchi University Hospital, Ube City, Yamaguchi Prefecture Japan.
Satoshi
S
Matsumoto
Intensive Care Unit, Yamaguchi University Hospital, Ube City, Yamaguchi Prefecture Japan.
Hiroya
H
Wakamatsu
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube City, Yamaguchi Prefecture Japan.
Ryosuke
R
Tsuruta
Intensive Care Unit, Yamaguchi University Hospital, Ube City, Yamaguchi Prefecture Japan.
Mishiya
M
Matsumoto
Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, Minami-Kogushi 1-1-1, Ube City, Yamaguchi Prefecture Japan.
Masaaki
M
Oka
Hemodynamic dysfunction; Intra-abdominal infection; Prognostic score