Garcia-Ramos Sergio, Caamaño Estrela, Rodríguez Benítez Patrocinio, Benito Pilar, Calvo Alberto, Ramos Silvia, Power Mercedes, Garutti Ignacio, Piñeiro Patricia
Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain.
Department of Nephrology, Gregorio Marañon National Hospital, 28007 Madrid, Spain.
J Pers Med. 2023 Jun 21;13(7):1023. doi: 10.3390/jpm13071023.
Endotoxin, a component of the cell membrane of gram-negative bacteria, is a trigger for dysregulated inflammatory response in sepsis. Extracorporeal purification of endotoxin, through adsorption with polymyxin B, has been studied as a therapeutic option for sepsis. Previous studies suggest that it could be effective in patients with high endotoxin levels or patients with septic shock of moderate severity. Here, we perform a retrospective, single-centre cohort study of 93 patients suffering from abdominal septic shock treated with polymyxin-B hemoperfusion (PMX-HP) between 2015 and 2020. We compared deceased and surviving patients one month after the intervention using X and Mann-Whitney U tests. We assessed the data before and after PMX-HP with a Wilcoxon single-rank test and a multivariate logistic regression analysis. There was a significant reduction of SOFA score in the survivors. The expected mortality using APACHE-II was 59.62%, whereas in our sample, the rate was 40.9%. We found significant differences between expected mortality and real mortality only for the group of patients with an SOFA score between 8 and 13. In conclusion, in patients with abdominal septic shock, the addition of PMX-HP to the standard therapy resulted in lower mortality than expected in the subgroup of patients with intermediate severity of illness.
内毒素是革兰氏阴性菌细胞膜的一种成分，是脓毒症中炎症反应失调的触发因素。通过多粘菌素B吸附进行内毒素的体外净化，已作为脓毒症的一种治疗选择进行了研究。先前的研究表明，它对内毒素水平高的患者或中度严重脓毒性休克患者可能有效。在此，我们对2015年至2020年间接受多粘菌素B血液灌流（PMX-HP）治疗的93例腹部脓毒性休克患者进行了一项回顾性单中心队列研究。我们使用X检验和曼-惠特尼U检验比较了干预后1个月死亡和存活的患者。我们用威尔科克森单秩检验和多变量逻辑回归分析评估了PMX-HP前后的数据。存活者的序贯器官衰竭评估（SOFA）评分显著降低。使用急性生理与慢性健康状况评分系统II（APACHE-II）预测的死亡率为59.62%，而在我们的样本中，该比率为40.9%。我们发现，仅在SOFA评分为8至13的患者组中，预期死亡率与实际死亡率存在显著差异。总之，在腹部脓毒性休克患者中，在标准治疗基础上加用PMX-HP导致疾病严重程度为中度的亚组患者死亡率低于预期。
