title: Polymyxin-B hemoperfusion in septic patients: analysis of a multicenter registry.
abstract: BACKGROUND
  In 2010, the EUPHAS 2 collaborative group created a registry with the purpose of recording data from critically ill patients suffering from severe sepsis and septic shock treated with polymyxin-B hemoperfusion (PMX-HP) for endotoxin removal. The aim of the registry was to verify the application of PMX-HP in the daily clinical practice.
  
  
  METHODS
  The EUPHAS 2 registry involved 57 centers between January 2010 and December 2014, collecting retrospective data of 357 patients (297 in Europe and 60 in Asia) suffering from severe sepsis and septic shock caused by proved or suspected infection related to Gram negative bacteria. All patients received atleast one cycle of extracorporeal endotoxin removal by PMX-HP.
  
  
  RESULTS
  Septic shock was diagnosed in 305 (85.4 %) patients. The most common source of infection was abdominal (44.0 %) followed by pulmonary (17.6 %). Gram negative bacteria represented 60.6 % of the pathogens responsible of infection. After 72 h from the first cycle of PMX-HP, some of the SOFA score components significantly improved with respect to baseline: cardiovascular (2.16 ± 1.77 from 3.32 ± 1.29, p < 0.0001), respiratory (1.95 ± 0.95 from 2.40 ± 1.06, p < 0.001) and renal (1.84 ± 1.77 from 2.23 ± 1.62, p = 0.013). Overall 28-day survival rate was 54.5 % (60.4 % in abdominal and 47.5 % in pulmonary infection). Patients with abdominal infection treated with PMX-HP within 24 h from the diagnosis of septic shock had a 28-day survival rate of 64.5 %. Patients showing a significantly cardiovascular improvement after PMX-HP had a 28-survival rate of 75 % in comparison to the 39 % of patients who did not (p < 0.001). Cox regression analysis found the variation of cardiovascular, respiratory and coagulation SOFA to be independent covariates for 28-day survival. In European patients were observed a higher 28-day (58.8 vs. 34.5 %, p = 0.003), ICU (59 vs. 36.7 %, p = 0.006) and hospital survival rate (53.2 vs. 35 %, p = 0.02) than in Asian patients. However, the two populations were highly heterogeneous in terms of source of infection and severity scores at admission.
  
  
  CONCLUSIONS
  The EUPHAS 2 is the largest registry conducted outside Japan on the clinical use of PMX-HP in septic patients. Data analysis confirmed the feasibility of PMX-HP to treat septic patients in daily clinical practice, showing clinical benefits associated with endotoxin removal without significant adverse events related to the extracorporeal technique.
authors: Department of Intensive Care and Anaesthesiology, Agostino Gemelli University Hospital, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168, Rome, Italy. sl.cutuli@gmail.com.
authors: Salvatore Lucio
authors: SL
authors: Cutuli
authors: Critical Care Center, Sabadell Hospital, CIBER Enfermedades Respiratorias, Corporació Sanitària Universitària Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors: Antonio
authors: A
authors: Artigas
authors: Department of Anaesthesia and Intensive Care Medicine, Niguarda Ca' Granda Hospital, University of Milan-Bicocca, Milan, Italy.
authors: Roberto
authors: R
authors: Fumagalli
authors: Department of Anaesthesia and Intensive Care Medicine, Niguarda Ca' Granda Hospital, University of Milan-Bicocca, Milan, Italy.
authors: Gianpaola
authors: G
authors: Monti
authors: Department of Anaesthesia and Intensive Care Medicine, University of Rome "La Sapienza", Rome, Italy.
authors: Vito Marco
authors: VM
authors: Ranieri
authors: Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.
authors: Claudio
authors: C
authors: Ronco
authors: Department of Intensive Care and Anaesthesiology, Agostino Gemelli University Hospital, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168, Rome, Italy.
authors: Massimo
authors: M
authors: Antonelli
keywords: EAA; Extracorporeal endotoxin removal; Infection; Polymyxin-B hemoperfusion; Sepsis; Septic shock