Hemodynamic response by polymyxin B hemoperfusion and its clinical outcomes in patients with refractory septic shock: A post-hoc sub-analysis of prospective cohort study
Kyohei Miyamoto, Yu Kawazoe, Noriko Miyagawa, Hitoshi Yamamura, Yoshinori Ohta, Takuya Kimura, Yukitoshi Toyoda, Michihito Kyo, Tetsuya Sato, Masashi Kinjo, Masaki Takahashi, Junichi Maruyama, Hiroshi Matsuura, Kazunori Fukushima, Satoru Murata, Tomoya Okazaki, Tsuyoshi Suzuki, Toshihiro Sakurai, Gaku Takahashi, Tasuku Hanajima, Takeshi MorimotoAbstract
Background
Polymyxin B hemoperfusion (PMX-HP) reportedly improves hemodynamic status in some but not all patients with septic shock. We examined the association between hemodynamic response and clinical outcomes and explored factors that may identify patients with hemodynamic response.
Methods
BEAT-SHOCK registry is a prospective cohort study of 309 consecutive adult patients with septic shock requiring high-dose norepinephrine. This predefined sub-analysis included 82 patients treated with PMX-HP. We defined hemodynamic response as a ≥ 20% improvement within 6 h of starting PMX-HP in the modified vasopressor dependency index, representing vasopressor dosage divided by mean arterial pressure.
Results
The median modified vasopressor dependency index at the start of PMX-HP was 0.56 mmHg-1, and 0.34 mmHg-1 6 h after starting PMX-HP (median relative change -32%). Hemodynamic response was obtained in 53 patients (65%; responder group). The 28-day mortality rate was 8% (4/53) in the responder group and 31% (9/29) in the non-responder group (
Conclusions
Among patients with refractory septic shock, 65% had hemodynamic response after PMX-HP, and it was associated with better clinical outcomes, as shown by the higher survival rate. The number of the following factors was associated with the likelihood of hemodynamic response: less organ dysfunction, more vasopressors, and abdominal/urinary tract infection.
Trial registration
UMIN Clinical Trial Registry on 1 November 2019 (registration no. UMIN000038302)