Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock

doi:10.4240/wjgs.v11.i12.422

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Dec 27, 2019 (publication date) through Jun 12, 2024

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Dec 27, 2019; 11(12): 422-432
Published online Dec 27, 2019. doi: 10.4240/wjgs.v11.i12.422

Table 1 Baseline patient characteristics in propensity-matched groups

	PMX-HP (n = 20)	Control (n = 20)	P value
Age, yr	66.7 ± 9.9	67.8 ± 10.2	0.719
Sex, Male, n (%)	12 (60.0)	12 (60.0)	1.000
Underlying malignancy, n (%)	11 (55.0)	12 (60.0)	0.749
Pre-existing organ dysfunction, n (%)	13 (65.0)	13 (65.0)	1.000
Liver insufficiency	1 (5.0)	0 (0.0)	0.311
Chronic respiratory disorder	1 (5.0)	5 (25.0)	0.077
Chronic heart failure	0 (0.0)	2 (10.0)	0.147
Chronic hemodialysis	3 (15.0)	1 (5.0)	0.292
Immunocompromised	3 (15.0)	0 (0.0)	0.072
Use of vasoactive agents
Norepinephrine	18 (90.0)	16 (80.0)	0.376
Dopamine	3 (15.0)	9 (45.0)	0.038
Dobutamine	2 (10.0)	0 (0.0)	0.147
Vasopressin	10 (50.0)	1 (5.0)	0.001
Epinephrine	6 (30.0)	5 (26.3)	0.798
Disease severity
SOFA score	11.2 ± 5.8	10.0 ± 4.0	0.446
APACHE II	19.1 ± 6.5	18.0 ± 4.4	0.534

Results are expressed in mean ± standard deviation; PMX-HP: Polymyxin B hemoperfusion; APACHE II: Acute physiology and Chronic Health Evaluation; SOFA: Sequential Organ Failure Assessment.

Table 2 Characteristics of patients, laboratory findings, and treatment of sepsis in propensity-matched groups

	PMX-HP (n = 20)	Control (n = 20)	P value
Primary infection site, n (%)			0.166
Upper GI tract	0 (0.0)	3 (15.0)
Small bowel	4 (20.0)	7 (35.0)
Lower GI tract	14 (70.0)	10 (50.0)
Hepatobiliary system	1 (5.0)	0 (0.0)
Soft tissue infection	1 (5.0)	0 (0.0)
Microorganisms, n (%)
Gram-negative species	11 (55.0)	10 (50.0)	0.752
Gram-positive species	6 (30.0)	7 (35.0)	0.736
Fungus	4 (20.0)	3 (15.0)	0.677
No growth	5 (25.0)	7 (35.0)	0.490
Number of microorganisms, n (%)			0.747
Single microorganism	9 (45.0)	7 (35.0)
Multiple microorganisms	6 (30.0)	6 (30.0)
Laboratory test on admission
WBC, 10⁹/L	87.6 ± 64.9	94.0 ± 49.1	0.731
Platelet counts, 10⁹/L	130.0 ± 102.0	163.7 ± 133.5	0.375
Hb, g/L	9.6 ± 2.0	10.5 ± 2.2	0.178
PT, %	45.7 ± 24.4	55.0 ± 16.5	0.168
Lactate, mmol/L	7.8 ± 6.9	7.2 ± 3.1	0.738
Methods of infection control, n (%)			1.000
Surgical intervention	19 (95.0)	19 (95.0)
Radiologic intervention	1 (5.0)	1 (5.0)
Other therapeutic management, n (%)
pRBC transfusion, n (%)	11 (55.0)	19 (95.0)	0.006
Mechanical ventilator	14 (70.0)	16 (80.0)	0.537
Re-intubation	3 (15.0)	2 (10.0)	0.633
RRT	9 (45.0)	8 (40.0)	0.749

GI: Gastrointestinal system; Hb: Hemoglobin; pRBC: Packed red blood cells; PT: Prothrombin tine; RRT: Renal replacement therapy; WBC: White blood cell count; PMX-HP: Polymyxin B hemoperfusion.

Table 3 Comparative analysis of variables changes between baseline and 72 h after treatment

Patients	PMX-HP (n = 20)		Control (n = 20)		P value
Patients	T_o¹	T₇₂²	T_o³	T₇₂⁴	P value
SOFA score	11.2 ± 5.8	4.7 ± 3.5	10.0 ± 4.0	8.7 ± 7.3	0.047^a
Respiratory SOFA	2.6 ± 1.0	1.9 ± 1.0	2.6 ± 1.5	1.8 ± 1.0	0.799
Cardiovascular SOFA	3.4 ± 1.2	0.4 ± 0.9	2.3 ± 1.8	1.2 ± 1.3	0.072
Liver SOFA	0.7 ± 0.9	1.1 ± 1.5	0.7 ± 1.3	1.4 ± 1.3	0.683
Renal SOFA	2.6 ± 1.0	0.7 ± 1.0	2.6 ± 1.5	2.8 ± 1.6	0.000^a
Coagulation SOFA	1.6 ± 1.5	1.3 ± 1.3	1.2 ± 1.2	2.8 ± 1.8	0.014^a
WBC, 10⁹/L	87.7 ± 65.0	102.5 ± 62.7	94.0 ± 49.1	115.6 ± 59.0	0.552
Hb, g/L	9.6 ± 2.0	9.0 ± 0.9	10.5 ± 2.2	9.7 ± 1.0	0.024^a
Inotropic score	163.7 ± 302.1	8.9 ± 19.1	90.8 ± 181.7	1.4 ± 4.2	0.006^a
VDI	2.4 ± 3.4	0.1 ± 0.3	1.0 ± 2.0	0.0 ± 0.1	0.001^a

¹Immediately after completion of two session of polymyxin B hemoperfusion (PMX-HP);

²Seventy-two hours after completion of two session of PMX-HP;

³Immediately after surgical control;

⁴Seventy-two hours after conventional standard therapy according to survival sepsis campaign.

^aP < 0.05, compared with variables between just before initiating treatment and 72 h after initiating the treatment in PMX-HP group and control group. SOFA: Sequential organ failure assessment; WBC: White blood cell; Hb: Hemoglobin; VDI: Vasopressor dependency index; PMX-HP: Polymyxin B hemoperfusion.

Table 4 Mortality, length of Intensive care unit stay and ventilator free days in polymyxin B hemoperfusion and control groups

	PMX-HP (n = 20)	Control (n = 20)	P value
ICU mortality (%)	4 (20)	8 (40)	0.168
28-d mortality (%)	9 (45)	8 (40)	0.749
In hospital mortality (%)	10 (50)	10 (50)	1.000
Length of ICU stay (d)	10.9 ± 3.9 (5-19)	14.6 ± 6.4 (5-23)	0.036
Mechanical ventilator days (d)	5.1 ± 4.7 (0-16)	4.9 ± 5.4 (0-18)	0.926

ICU: Intensive care unit; PMX-HP: Polymyxin B hemoperfusion.

Citation: Kim JJ, Park YJ, Moon KY, Park JH, Jeong YK, Kim EY. Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock. World J Gastrointest Surg 2019; 11(12): 422-432
URL: https://www.wjgnet.com/1948-9366/full/v11/i12/422.htm
DOI: https://dx.doi.org/10.4240/wjgs.v11.i12.422