Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
Academia, Industry and Government Collaborative Research Institute of Translational Medicine for Life Innovation, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
Crit Care. 2017 Jun 7;21(1):134. doi: 10.1186/s13054-017-1712-3.
The purpose of this study was to investigate whether polymyxin B hemoperfusion (PMX-HP) improves the survival of patients with septic shock.
This was a retrospective, multicenter study conducted on patients treated during a 3-year period. We performed propensity-score analyses of the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study database. The study included data on 1723 patients with septic shock aged 16 years or older. Furthermore, we divided patients into to PMX-HP- and non-PMX-HP-treated groups. The primary endpoint was all-cause hospital mortality; secondary endpoints included intensive care unit (ICU) mortality and number of ICU-free days (ICUFDs) in the first 28 days.
Of 1,723 eligible patients, 522 had received PMX-HP. Propensity score matching created 262 matched pairs (i.e., 262 patients in each of the non-PMX-HP and PMX-HP groups). The proportion of all-cause hospital mortality was significantly lower in the PMX-HP group than in the non-PMX-HP group (32.8% vs. 41.2%; odds ratio (OR): 0.681; 95% confidence interval (CI): 0.470-0.987; P = 0.042). The number of ICUFD in the first 28 days was significantly higher in the PMX-HP group than in the non-PMX-HP group (18 (0-22) vs. 14 (0-22) days, respectively; P = 0.045). On the other hand, there was no significant difference in ICU mortality between the two groups (21.8% vs. 24.4%; OR: 0.844; CI: 0.548-1.300; P = 0.443).
Our results strongly suggest that PMX-HP reduces all-cause hospital mortality and length of ICU stay in patients with septic shock.
本研究旨在探讨多黏菌素 B 血液灌流（PMX-HP）是否能改善感染性休克患者的生存率。
这是一项回顾性、多中心研究，对三年内接受治疗的患者进行了研究。我们对日本感染性弥散性血管内凝血（JSEPTIC DIC）研究数据库进行了倾向评分分析。研究纳入了 1723 名年龄在 16 岁及以上的感染性休克患者的数据。此外，我们将患者分为 PMX-HP 治疗组和非 PMX-HP 治疗组。主要终点为全因住院死亡率；次要终点包括重症监护病房（ICU）死亡率和第 28 天内 ICU 无死亡率。
在 1723 名合格患者中，有 522 名接受了 PMX-HP 治疗。通过倾向评分匹配，创建了 262 对匹配对（即非 PMX-HP 组和 PMX-HP 组各 262 名患者）。PMX-HP 组的全因住院死亡率明显低于非 PMX-HP 组（32.8% vs. 41.2%；优势比（OR）：0.681；95%置信区间（CI）：0.470-0.987；P=0.042）。PMX-HP 组在第 28 天内的 ICU 无死亡率明显高于非 PMX-HP 组（18（0-22）vs. 14（0-22）天，P=0.045）。另一方面，两组 ICU 死亡率无显著差异（21.8% vs. 24.4%；OR：0.844；CI：0.548-1.300；P=0.443）。
我们的结果强烈表明，PMX-HP 可降低感染性休克患者的全因住院死亡率和 ICU 住院时间。
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