Okubo Aiko, Nakashima Ayumu, Doi Shigehiro, Ueno Toshinori, Sasaki Kensuke, Esaki Takashi, Masaki Takao
Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Stem Cell Biology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
Clin Exp Nephrol. 2018 Oct;22(5):1167-1173. doi: 10.1007/s10157-018-1548-4. Epub 2018 Feb 24.
The definition of sepsis was updated to sepsis-3 in February 2016. Currently, direct hemoperfusion therapy using the polymyxin B-immobilized fiber cartridge (PMX-DHP) is widely performed to treat sepsis and septic shock. However, the prognostic factors of PMX-DHPs in patients with sepsis using the new definition are unclear. We retrospectively assessed prognostic factors in patients who had received PMX-DHP therapy for sepsis and septic shock.
We included 71 patients with severe infection who underwent PMX-DHP treatment from January 2006 to August 2015 in this study. Participants were re-evaluated according to the criteria of sepsis-3. The patients were divided into two groups based on having survived (n = 59) or not survived (n = 12) for 28 days after PMX-DHP treatment. Clinical data before and after PMX-DHP treatment were compared between the two groups.
Non-survivors showed a lower Glasgow Coma Scale (GCS) score before PMX-DHP treatment compared with 28-day survivors [12 (6-14) vs 14 (12-15), P < 0.01]. Furthermore, pH after the first PMX-DHP session was significantly lower in non-survivors than in survivors (7.28 ± 0.23 vs 7.39 ± 0.06, P = 0.03). Multivariate logistic regression analysis showed that only lower pH after the first PMX-DHP session was a predictor of 28-day mortality independent of age, sex, GCS score, and mean arterial pressure (odds ratio per pH of 0.01, 0.93; 95% confidence interval, 0.83-0.99; P = 0.02).
The pH after the first PMX-DHP session is an independent risk factor for mortality in patients receiving PMX-DHP for sepsis and septic shock.
2016年2月，脓毒症的定义更新为脓毒症-3。目前，使用多粘菌素B固定纤维柱（PMX-DHP）的直接血液灌流疗法被广泛用于治疗脓毒症和脓毒性休克。然而，采用新定义时，PMX-DHP治疗脓毒症患者的预后因素尚不清楚。我们回顾性评估了接受PMX-DHP治疗脓毒症和脓毒性休克患者的预后因素。
本研究纳入了2006年1月至2015年8月期间接受PMX-DHP治疗的71例严重感染患者。参与者根据脓毒症-3标准重新评估。根据PMX-DHP治疗后28天存活（n = 59）或未存活（n = 12）将患者分为两组。比较两组PMX-DHP治疗前后的临床数据。
与28天存活者相比，非存活者在PMX-DHP治疗前的格拉斯哥昏迷量表（GCS）评分更低[12（6-14）对14（12-15），P < 0.01]。此外，首次PMX-DHP治疗后非存活者的pH值显著低于存活者（7.28 ± 0.23对7.39 ± 0.06，P = 0.03）。多因素逻辑回归分析显示，仅首次PMX-DHP治疗后的较低pH值是28天死亡率的独立预测因素，独立于年龄、性别、GCS评分和平均动脉压（每pH值0.01的优势比为0.93；95%置信区间，0.83-0.99；P = 0.02）。
首次PMX-DHP治疗后的pH值是接受PMX-DHP治疗脓毒症和脓毒性休克患者死亡的独立危险因素。
