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pH after the first session of direct hemoperfusion with polymyxin B-immobilized fibers predicts mortality in patients with sepsis and septic shock

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Abstract

Background

The definition of sepsis was updated to sepsis-3 in February 2016. Currently, direct hemoperfusion therapy using the polymyxin B-immobilized fiber cartridge (PMX-DHP) is widely performed to treat sepsis and septic shock. However, the prognostic factors of PMX-DHPs in patients with sepsis using the new definition are unclear. We retrospectively assessed prognostic factors in patients who had received PMX-DHP therapy for sepsis and septic shock.

Methods

We included 71 patients with severe infection who underwent PMX-DHP treatment from January 2006 to August 2015 in this study. Participants were re-evaluated according to the criteria of sepsis-3. The patients were divided into two groups based on having survived (n = 59) or not survived (n = 12) for 28 days after PMX-DHP treatment. Clinical data before and after PMX-DHP treatment were compared between the two groups.

Results

Non-survivors showed a lower Glasgow Coma Scale (GCS) score before PMX-DHP treatment compared with 28-day survivors [12 (6–14) vs 14 (12–15), P < 0.01]. Furthermore, pH after the first PMX-DHP session was significantly lower in non-survivors than in survivors (7.28 ± 0.23 vs 7.39 ± 0.06, P = 0.03). Multivariate logistic regression analysis showed that only lower pH after the first PMX-DHP session was a predictor of 28-day mortality independent of age, sex, GCS score, and mean arterial pressure (odds ratio per pH of 0.01, 0.93; 95% confidence interval, 0.83–0.99; P = 0.02).

Conclusion

The pH after the first PMX-DHP session is an independent risk factor for mortality in patients receiving PMX-DHP for sepsis and septic shock.

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References

  1. Angus DC, Linde-Zwirble WT, Lidicker J, Clemont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.

    Article  CAS  Google Scholar 

  2. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.

    Article  CAS  Google Scholar 

  3. Beutler RE. Innate immune sensing and its roots: the story of endotoxin. Nat Rev Immunol. 2003;3(2):169–76.

    Article  CAS  Google Scholar 

  4. Shoji H. Extracorporeal endotoxin removal for the treatment of sepsis: endotoxin adsorption cartridge (Toraymyxin). Ther Apher Dial. 2003;7:108–14.

    Article  CAS  Google Scholar 

  5. Iba T, Okamoto K, Kawasaki S, Nakarai E, Miyasho T. Effect of hemoperfusion using polumyxin B-immobilized fibers on non-shock rat sepsis model. J Surg Res. 2011;171(2):755–61.

    Article  CAS  Google Scholar 

  6. Payen DM, Guilhot J, Launey Y, Lukaszewicz AC, Kaaki M, Veber B, et al. ABDOMIX group. Early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: a multicenter randomized control trial. Intensive Care Med. 2015;41(6):975–84.

    Article  CAS  Google Scholar 

  7. Cruz DN, Perazella MA, Bellomo R, de Cal M, Polanco N, Corradi V, et al. Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Crit Care. 2007;11(2):R47.

    Article  Google Scholar 

  8. Cantaluppi V, Assenzio B, Pasero D, Romanazzi GM, Pacitti A, Lanfranco G, et al. Polymyxin-B hemoperfusion inactivates circulating proapoptotic factors. Intensive Care Med. 2008;34(9):1638–45.

    Article  Google Scholar 

  9. Kohro S, Imaizumi H, Yamakage M, Masuda Y, Namiki A, Asai Y, et al. Anandamide absorption by direct hemoperfusion with polymyxin B-immobilized fiber improves the prognosis and organ failure assessment score in patients with sepsis. J Anesth. 2006;20(1):11–6.

    Article  Google Scholar 

  10. Vincent JL, Laterre PF, Cohen J, Burchardi H, Bruining H, Lerma FA,et al. A pilot-controlled study of a polymyxin B-immobilized hemoperfusion cartridge in patients with severe sepsis secondary to intra-abdominal infection. Shock. 2005;23(5):400–05.

    Article  CAS  Google Scholar 

  11. Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A,et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA. 2009;301(23):2445–52.

    Article  CAS  Google Scholar 

  12. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.

    Article  Google Scholar 

  13. Suetrong B, Walley KR. Lactic acidosis in sepsis: it’s not all anaerobic: implications for diagnosis and management. Chest. 2016;149(1):252–61.

    Article  Google Scholar 

  14. Komatsu S, Shimomatsuya T, Nakajima M, Ono S, Maruhashi K. Severity scoring systems for prognosis and efficacy of polymyxin B-immobilized fiber treatment for colonic perforation. Surg Today. 2006;36(9):807–10.

    Article  CAS  Google Scholar 

  15. Sugimoto K, Sato K, Maekawa H, Sakurada M, Orita H, Ito T, et al. Analysis of the efficacy of direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) according to the prognostic factors in patients with colorectal perforation. Surg Today. 2013;43(9):1031–38.

    Article  CAS  Google Scholar 

  16. Matsukuma S, Sakamoto K, Nishiyama M, Tamesa T, Yoshino S, Hazama S, et al. Prognostic factors in patients with septic shock in digestive surgery who have undergone direct hemoperfusion with polymyxin B-immobilized fibers: a retrospective observational study. J Intensive Care. 2015;3:13.

    Article  Google Scholar 

  17. Ishizuka M, Tago K, Kubota K. Impact of prothrombin time-international normalized ratio on outcome of patients with septic shock receiving polymyxin B cartridge hemoperfusion. Surgery. 2014;156(1):168–75.

    Article  Google Scholar 

  18. Yamato M, Minematsu Y, Fujii J, Mori K, Minato T, Miyagawa S, et al. Effective combination therapy of polymyxin-B direct hemoperfusion and recombinant thrombomodulin for septic shock accompanied by disseminated intravascular coagulation: a historical controlled trial. Ther Apher Dial. 2013;17(5):472–76.

    Article  CAS  Google Scholar 

  19. Abe S, Hayashi H, Seo Y, Matsuda K, Kamio K, Saito Y, et al. Reduction in serum high mobility group box-1 level by polymyxin B-immobilized fiber column in patients with idiopathic pulmonary fibrosis with acute exacerbation. Blood Purif. 2011;32(4):310–16.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Aiko Okubo, Ayumu Nakashima, Shigehiro Doi, Toshinori Ueno, Kensuke Sasaki & Takao Masaki

  2. Department of Stem Cell Biology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan

    Ayumu Nakashima

  3. Department of Nephrology, Onomichi General Hospital, Hiroshima, Japan

    Takashi Esaki

Authors
  1. Aiko Okubo
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  2. Ayumu Nakashima
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  3. Shigehiro Doi
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  4. Toshinori Ueno
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  5. Kensuke Sasaki
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  6. Takashi Esaki
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  7. Takao Masaki
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Corresponding authors

Correspondence to Ayumu Nakashima or Takao Masaki.

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Conflict of interest

All of the authors have declared that no conflict of interest exist.

Ethical approval

This study was performed in accordance with the guidelines contained within the Declaration of Helsinki and the protocol was licensed by the hospital ethics committee of Hiroshima University Hospital (approval number: E-726, registered on March 29, 2017).

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Written informed consent was not required because of the non-intervention and retrospective design.

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Okubo, A., Nakashima, A., Doi, S. et al. pH after the first session of direct hemoperfusion with polymyxin B-immobilized fibers predicts mortality in patients with sepsis and septic shock. Clin Exp Nephrol 22, 1167–1173 (2018). https://doi.org/10.1007/s10157-018-1548-4

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  • DOI: https://doi.org/10.1007/s10157-018-1548-4

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