Yamada Hiroyuki, Tsukamoto Tatsuo, Narumiya Hiromichi, Oda Kazumasa, Higaki Satoshi, Iizuka Ryoji, Yanagita Motoko, Deguchi Masako
Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan ; Department of Metabolism, Nephrology and Rheumatology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi, Kamigyo-ku, Kyoto, 602-8026 Japan.
Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan.
J Intensive Care. 2016 Oct 10;4:64. doi: 10.1186/s40560-016-0186-8. eCollection 2016.
Direct hemoperfusion with polymyxin B-immobilized fiber column (PMX-DHP) could improve the hemodynamic status of septic shock patients. As PMX-DHP is an invasive and costly procedure, it is desirable to estimate the therapeutic effect before performing the therapy. However, it is still unclear when this therapy should be started and what type of sepsis it should be employed for. In this study, we retrospectively examined the clinical effect of patients treated with PMX-DHP by using central venous pressure (CVP).
Seventy patients who received PMX-DHP for septic shock during the study period were recruited and divided into a low CVP group ( = 33, CVP < 12 mmHg) and a high CVP group ( = 37, CVP≧12 mmHg). The primary endpoint was vasopressor dependency index at 24 hours after starting PMX-DHP, and the secondary endpoint was the 28-day survival rate. Additionally, we performed a multivariate linear regression analysis on the difference in the vasopressor dependency index.
The vasopressor dependency index significantly improved at 24 h in the low CVP group (0.33 to 0.16 mmHg; < 0.01) but not in the high CVP group (0.43 to 0.34 mmHg; = 0.41), and there was a significant difference between the two groups in the index at 24 h ( = 0.02). The 28-day survival rate was higher in the low CVP group (79 vs. 43 %; < 0.01). Multivariate linear regression analysis showed that CVP ( = 0.04) was independently associated with the difference in the vasopressor dependency index.
Our study indicates that the clinical effect of PMX-DHP for septic shock patients with higher CVP (≧12 mmHg) might be limited and that the initial CVP when performing PMX-DHP could function as an independent prognostic marker for the hemodynamic improvement.
使用多粘菌素B固定化纤维柱进行直接血液灌流（PMX-DHP）可改善感染性休克患者的血流动力学状态。由于PMX-DHP是一种侵入性且成本高昂的治疗方法，因此在进行治疗前预估其治疗效果很有必要。然而，目前仍不清楚该治疗应何时开始以及适用于何种类型的脓毒症。在本研究中，我们通过中心静脉压（CVP）回顾性研究了接受PMX-DHP治疗患者的临床效果。
招募了70例在研究期间因感染性休克接受PMX-DHP治疗的患者，并将其分为低CVP组（n = 33，CVP < 12 mmHg）和高CVP组（n = 37，CVP≥12 mmHg）。主要终点是开始PMX-DHP治疗24小时后的血管升压药依赖指数，次要终点是28天生存率。此外，我们对血管升压药依赖指数的差异进行了多变量线性回归分析。
低CVP组在24小时时血管升压药依赖指数显著改善（从0.33降至0.16 mmHg；P < 0.01），而高CVP组未改善（从0.43降至0.34 mmHg；P = 0.41），两组在24小时时的指数存在显著差异（P = 0.02）。低CVP组的28天生存率更高（79%对43%；P < 0.01）。多变量线性回归分析显示，CVP（P = 0.04）与血管升压药依赖指数的差异独立相关。
我们的研究表明，PMX-DHP对CVP较高（≥12 mmHg）的感染性休克患者的临床效果可能有限，并且进行PMX-DHP时的初始CVP可作为血流动力学改善的独立预后标志物。
