Efficacy of Postoperative Polymyxin B Hemoperfusion in Secondary Peritonitis Patients with Septic Shock: A Propensity-Matched Analysis

Introduction Severe sepsis and septic shock is still a challenge. Polymyxin B hemoperfusion (PMX) is a device designed to remove circulating endotoxin by adsorption, which is reported to improve treatment outcomes. This study aimed to further verify the efficacy of PMX on postoperative, peritonitis, septic shock patients. Methods This study prospectively analyzed 20 of 155 patients who presented with postoperative septic shock and were treated with PMX in a single institute during the period March 2013 to September 2014 (Clinical Trial Protocol number: ChiCTR-ONC-16008160). A control group (53 patients) was recruited from our own 2012 database using the propensity-matching score method. The data collection includes demographic data, postoperative organ dysfunction status, disease severity and treatment result. Results The 2 groups (treatment vs. control) were similar in demographic data, organ dysfunction status and disease severity. PMX use provides benefits for recovery of hemodynamic status and many other aspects, including better survival, but is not statistically significant. For survival factor analysis, PMX use is also not significant for patient survival in our study. Conclusions PMX provided some benefits to patients in the treatment for peritonitis septic shock. An improvement in hemodynamic status was mostly observed. Our study also supports the finding that PMX used as an auxiliary treatment provides improved survival but is not statistically significant, possibly due to the small sample size with multiple comorbidities.

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Effects of Polymyxin B Hemoperfusion on Septic Shock Patients Requiring Noradrenaline: Analysis of a Nationwide Administrative Database in Japan

Blood Purification ◽

10.1159/000513213 ◽

2021 ◽

pp. 1-6

Author(s):

Kenji Fujimori ◽

Kunio Tarasawa ◽

Kiyohide Fushimi

Keyword(s):

Septic Shock ◽

Propensity Score ◽

Propensity Score Matching ◽

Polymyxin B ◽

Administrative Database ◽

Control Group ◽

Continuous Hemodiafiltration ◽

Significant Survival ◽

Maximum Daily Dose ◽

Polymyxin B Hemoperfusion

Introduction: Polymyxin B hemoperfusion (PMX) reduces endotoxin in septic shock patients’ blood and can improve hemodynamics and organ functions. However, its effects on the reduction of septic shock mortality are controversial. Methods: Using the Japanese diagnosis procedure combination database from April 2016 to March 2019, we identified adult septic shock patients treated with noradrenaline. This study used propensity score matching to compare the outcome between PMX-treated and non-treated patients. The primary endpoint was 28-day mortality, counting from the day of noradrenaline initiation. The secondary endpoints were noradrenaline-, ventilator-, and continuous hemodiafiltration (CHDF)-free days at day 28. Results: Of 30,731 eligible patients, 4,766 received PMX. Propensity score matching produced a matched cohort of 4,141 pairs with well-balanced patient backgrounds. The 28-day survival rate was 77.9% in the PMX group and 71.1% in the control group (p < 0.0001). Median days of noradrenalin-, CHDF-, and ventilator-free days were 2 days (p < 0.0001), 2 days (p < 0.0001), and 6 days (p < 0.0001) longer in the PMX group than in the control group, respectively. When stratified with the maximum daily dose of noradrenaline, the PMX group showed a statistically significant survival benefit in the groups with noradrenaline dose <20 mg/day but not in the noradrenaline group dose ≥20 mg/day. Conclusion: Analysis of large Japanese databases showed that septic shock patients who received noradrenaline might benefit from PMX treatment.

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Potential Survival Benefit of Polymyxin B Hemoperfusion in Septic Shock Patients on Continuous Renal Replacement Therapy: A Propensity-Matched Analysis

Blood Purification ◽

10.1159/000444474 ◽

2016 ◽

Vol 42 (1) ◽

pp. 9-17 ◽

Cited By ~ 23

Author(s):

Masao Iwagami ◽

Hideo Yasunaga ◽

Eisei Noiri ◽

Hiromasa Horiguchi ◽

Kiyohide Fushimi ◽

...

Keyword(s):

Septic Shock ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Survival Benefit ◽

Propensity Scores ◽

Polymyxin B ◽

Control Group ◽

Diagnosis Procedure Combination ◽

Polymyxin B Hemoperfusion

Background/Aims: We assessed the survival benefit of polymyxin B hemoperfusion (PMX) in septic shock patients starting continuous renal replacement therapy (CRRT), who are known to have an increased rate of mortality. Methods: Adult patients in the Japanese diagnosis procedure combination database satisfying the following criteria were enrolled: hospitalized in 2007-2012; diagnosed as having sepsis; required noradrenaline and/or dopamine; and started CRRT in intensive care unit. Propensity scores for receiving PMX were created from patient and hospital characteristics. Results: Of 3,759 eligible patients, 1,068 received PMX. Propensity-score matching produced a matched cohort of 978 pairs. The 28-day mortality was 40.2% (393/978) in the PMX group and 46.8% (458/978) in the control group (p = 0.003). Logistic regression analysis revealed a significant association between the use of PMX and decreased 28-day mortality (adjusted OR 0.75; 95% CI 0.62-0.91). Conclusion: This large retrospective study suggests that septic shock patients starting CRRT may benefit from PMX.

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Faculty Opinions recommendation of Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1163099.623758 ◽

2009 ◽

Author(s):

Martin Duenser

Keyword(s):

Septic Shock ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Polymyxin B ◽

Randomized Controlled ◽

Early Use ◽

Polymyxin B Hemoperfusion

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Combination Therapies for Hidradenitis Suppurativa: A Retrospective Chart Review of 31 Patients

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475418823529 ◽

2019 ◽

Vol 23 (3) ◽

pp. 270-276 ◽

Cited By ~ 6

Author(s):

Meghan L. McPhie ◽

Alanna C. Bridgman ◽

Mark G. Kirchhof

Keyword(s):

Disease Severity ◽

Hidradenitis Suppurativa ◽

Chart Review ◽

Small Sample Size ◽

Demographic Data ◽

Severe Disease ◽

Treatment Protocol ◽

Retrospective Chart Review ◽

Small Sample ◽

Combination Therapies

Background: Although a variety of medical and surgical interventions exist for the treatment of hidradenitis suppurativa (HS), it remains a challenging disease to manage because of its variable presentation and unpredictable clinical course. Apart from the combination of clindamycin and rifampin, the success of other combination therapies is largely unknown. Objectives: The goal of our study was to examine the clinical utility of various combination therapies for the treatment of HS. Methods: We conducted a qualitative retrospective chart review of 31 patients with dermatologist-diagnosed HS who were seen at an academic teaching hospital between 2014 and 2018. Demographic data, disease location, disease severity, and treatment protocol were retrieved for analysis. Hurley stage was used to classify disease severity on initial presentation, and the International Hidradenitis Suppurativa Severity Score System (IHS4) was used to track changes across visits. Results: Of the 31 patients (Mage = 37.7 years; 67.7% female) included in the study, 6 (19.4%), 11 (35.5%), and 14 (45.2%) patients were classified as Hurley stages I, II, and III, respectively. Although no statistical results are provided because of the small sample size, we have identified several drug combinations that show promising clinical response for patients with HS based on their IHS4 score, such as isotretinoin/spironolactone for mild disease, isotretinoin or doxycycline with adalimumab for moderate disease, and cyclosporine/adalimumab for severe disease. Conclusions: This preliminary work demonstrates that HS treatment with combination therapy appears to be a promising method of disease management.

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