Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan,
Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan.
Blood Purif. 2021;50(4-5):560-565. doi: 10.1159/000513213. Epub 2021 Feb 12.
Polymyxin B hemoperfusion (PMX) reduces endotoxin in septic shock patients' blood and can improve hemodynamics and organ functions. However, its effects on the reduction of septic shock mortality are controversial.
Using the Japanese diagnosis procedure combination database from April 2016 to March 2019, we identified adult septic shock patients treated with noradrenaline. This study used propensity score matching to compare the outcome between PMX-treated and non-treated patients. The primary endpoint was 28-day mortality, counting from the day of noradrenaline initiation. The secondary endpoints were noradrenaline-, ventilator-, and continuous hemodiafiltration (CHDF)-free days at day 28.
Of 30,731 eligible patients, 4,766 received PMX. Propensity score matching produced a matched cohort of 4,141 pairs with well-balanced patient backgrounds. The 28-day survival rate was 77.9% in the PMX group and 71.1% in the control group (p < 0.0001). Median days of noradrenalin-, CHDF-, and ventilator-free days were 2 days (p < 0.0001), 2 days (p < 0.0001), and 6 days (p < 0.0001) longer in the PMX group than in the control group, respectively. When stratified with the maximum daily dose of noradrenaline, the PMX group showed a statistically significant survival benefit in the groups with noradrenaline dose <20 mg/day but not in the noradrenaline group dose ≥20 mg/day.
Analysis of large Japanese databases showed that septic shock patients who received noradrenaline might benefit from PMX treatment.
多黏菌素 B 血液灌流（PMX）可降低脓毒性休克患者血液中的内毒素，并改善血液动力学和器官功能。然而，其对降低脓毒性休克死亡率的影响仍存在争议。
使用 2016 年 4 月至 2019 年 3 月的日本诊断程序组合数据库，我们确定了接受去甲肾上腺素治疗的成年脓毒性休克患者。本研究使用倾向评分匹配来比较 PMX 治疗组和未治疗组的结果。主要终点是从去甲肾上腺素开始的第 28 天的死亡率。次要终点是第 28 天去甲肾上腺素、呼吸机和连续血液透析滤过（CHDF）无天数。
在 30731 名合格患者中，有 4766 名接受了 PMX。倾向评分匹配产生了一个匹配队列，其中包括 4141 对患者，患者背景得到了很好的平衡。PMX 组的 28 天生存率为 77.9%，对照组为 71.1%（p < 0.0001）。PMX 组的去甲肾上腺素、CHDF 和呼吸机无天数中位数分别为 2 天（p < 0.0001）、2 天（p < 0.0001）和 6 天（p < 0.0001）长于对照组。当按去甲肾上腺素的最大日剂量分层时，PMX 组在去甲肾上腺素剂量<20 mg/天的组中显示出统计学上的生存获益，但在去甲肾上腺素剂量≥20 mg/天的组中则没有。
对日本大型数据库的分析表明，接受去甲肾上腺素治疗的脓毒性休克患者可能从 PMX 治疗中受益。
