Ishizuka Mitsuru, Terasaki Azusa, Kubota Keiichi
Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
J Surg Res. 2016 Jan;200(1):308-14. doi: 10.1016/j.jss.2015.07.041. Epub 2015 Aug 6.
Although polymyxin B cartridge hemoperfusion (PMX) has an important place in the treatment of patients with severe sepsis and/or septic shock (SS), there are few rigid indications for performing PMX a second time.The objective of the study was to investigate the clinicolaboratory characteristics (CCs) showing the most significant change from the first to the second PMX and associated with 28-d mortality in patients with SS.
Between April 2006 and March 2008, 78 patients with SS who had received two sessions of PMX in a prospectively collected multicenter collaboration study were enrolled. Univariate and multivariate analyses using the differences in the values of individual CCs (Δ-CCs) were performed to assess the CCs showing the most significant change in value associated with 28-d mortality. The Δ-CC was defined as: Δ2nd-1st-CC = value of the CC just before the second PMX - value of the CC just before the first PMX.
Among 28 Δ2nd-1st-CCs, 10 Δ2nd-1st-CCs were selected by using receiver operating characteristic (ROC) curve analyses. The results of multivariate analysis using adequate 8 Δ2nd-1st-CCs that had been selected by univariate analyses revealed that only Δ2nd-1st-prothrombin time-international normalized ratio (PT-INR) (≤0.16/>0.16; hazard ratio = 6.562; 95% CI = 1.525-28.23; P = 0.012) was associated with 28-d mortality. Survival curve analysis demonstrated a significant difference in 28-d mortality between patients with a lower (≤0.16) and a higher (>0.16) Δ2nd-1st-PT-INR (P < 0.001).
Patients with exacerbation of PT-INR (>0.16) after initial PMX are unlikely to benefit clinically from a second PMX for treatment of SS.
尽管多粘菌素B柱式血液灌流（PMX）在严重脓毒症和/或脓毒性休克（SS）患者的治疗中占有重要地位，但再次进行PMX治疗的严格指征却很少。本研究的目的是调查临床实验室特征（CCs），这些特征显示从首次到第二次PMX有最显著的变化，并与SS患者的28天死亡率相关。
在2006年4月至2008年3月期间，纳入了78例在一项前瞻性收集的多中心合作研究中接受过两次PMX治疗的SS患者。使用个体CCs值的差异（Δ-CCs）进行单因素和多因素分析，以评估与28天死亡率相关的CCs值变化最显著的特征。Δ-CC定义为：Δ2nd-1st-CC = 第二次PMX前CC的值 - 第一次PMX前CC的值。
在28个Δ2nd-1st-CCs中，通过使用受试者工作特征（ROC）曲线分析选择了10个Δ2nd-1st-CCs。使用单因素分析选择的8个合适的Δ2nd-1st-CCs进行多因素分析的结果显示，只有Δ2nd-1st-凝血酶原时间-国际标准化比值（PT-INR）（≤0.16/>0.16；风险比 = 6.562；95%CI = 1.525 - 28.23；P = 0.012）与28天死亡率相关。生存曲线分析表明，较低（≤0.16）和较高（>0.16）的Δ2nd-1st-PT-INR患者在28天死亡率方面存在显著差异（P < 0.001）。
初次PMX后PT-INR恶化（>0.16）的患者不太可能从第二次PMX治疗SS中获得临床益处。
