Iwagami Masao, Yasunaga Hideo, Noiri Eisei, Horiguchi Hiromasa, Fushimi Kiyohide, Matsubara Takehiro, Yahagi Naoki, Nangaku Masaomi, Doi Kent
Department of Hemodialysis and Apheresis, School of Public Health, The University of Tokyo Hospital, Tokyo, Japan.
Blood Purif. 2016;42(1):9-17. doi: 10.1159/000444474. Epub 2016 Feb 27.
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.
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.
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).
This large retrospective study suggests that septic shock patients starting CRRT may benefit from PMX.
背景/目的：我们评估了多粘菌素B血液灌流（PMX）对开始接受持续肾脏替代治疗（CRRT）的感染性休克患者的生存获益，这类患者已知死亡率较高。
纳入日本诊断流程组合数据库中符合以下标准的成年患者：2007年至2012年住院；诊断为脓毒症；需要去甲肾上腺素和/或多巴胺；在重症监护病房开始接受CRRT。根据患者和医院特征创建接受PMX的倾向评分。
在3759例符合条件的患者中，1068例接受了PMX。倾向评分匹配产生了978对匹配队列。PMX组28天死亡率为40.2%（393/978），对照组为46.8%（458/978）（p = 0.003）。逻辑回归分析显示，使用PMX与降低28天死亡率之间存在显著关联（调整后的OR为0.75；95%CI为0.62 - 0.91）。
这项大型回顾性研究表明，开始接受CRRT的感染性休克患者可能从PMX中获益。
