Cutuli Salvatore Lucio, Carelli Simone, Cascarano Laura, Cicconi Sandra, Silvestri Davide, Cicetti Marta, Vallecoccia Maria Sole, Pintaudi Gabriele, Tanzarella Eloisa Sofia, Grieco Domenico Luca, Antonelli Massimo, De Pascale Gennaro
Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
Artif Organs. 2023 Dec;47(12):1865-1873. doi: 10.1111/aor.14645. Epub 2023 Sep 22.
To explore the association between endotoxin activity (EA) and septic cardiomyopathy (SCM), the relationship between endotoxin removal by Polymyxin-B hemoperfusion (PMX-HP) and recovery from SCM (R-SCM), and the correlation between R-SCM and the 28-day mortality in septic patients admitted to the intensive care unit (ICU).
Observational study that included patients admitted to two ICUs of a tertiary university hospital between April 2011 and December 2019, who received PMX-HP for sepsis/septic shock. The SCM and R-SCM were assessed by transthoracic echocardiography.
Among 148 patients, SCM was diagnosed in 60 (46%) of them and had no relationship with median EA (SCM group: 0.73; no-SCM group: 0.66, p = 0.48). Recovery from SCM was observed in 24 patients (49%) and was independently associated with the PMX-HP (OR 4.19, 95%CI [1.22, 14.3]; p = 0.02) and the SAPS2 II score (OR 0.94, 95%CI [0.9, 0.98]; p = 0.006). In the SCM group, the 28-day mortality was 60% and was independently predicted by R-SCM (OR 0.02, 95%CI [0.001, 0.3] p = 0.005) and SAPS II score (OR 1.11, 95%CI [1.01, 1.23] p = 0.037).
In septic patients, EA was not associated with SCM. However, endotoxin removal by Polymyxin-B hemoperfusion was associated with recovery from cardiomyopathy, which was a predictor of lower 28-day mortality.
探讨内毒素活性（EA）与脓毒症性心肌病（SCM）之间的关联、多黏菌素B血液灌流（PMX-HP）清除内毒素与SCM恢复（R-SCM）之间的关系，以及R-SCM与入住重症监护病房（ICU）的脓毒症患者28天死亡率之间的相关性。
一项观察性研究，纳入了2011年4月至2019年12月期间在一所三级大学医院的两个ICU住院、因脓毒症/脓毒症休克接受PMX-HP治疗的患者。通过经胸超声心动图评估SCM和R-SCM。
148例患者中，60例（46%）被诊断为SCM，且与中位EA无关（SCM组：0.73；非SCM组：0.66，p = 0.48）。24例患者（49%）出现SCM恢复，且与PMX-HP（比值比4.19，95%置信区间[1.22, 14.3]；p = 0.02）和简化急性生理学评分系统II（SAPS2 II）评分（比值比0.94，95%置信区间[0.9, 0.98]；p = 0.006）独立相关。在SCM组中，28天死亡率为60%，且由R-SCM（比值比0.02，95%置信区间[0.001, 0.3]，p = 0.005）和SAPS II评分（比值比1.11，95%置信区间[1.01, 1.23]，p = 0.037）独立预测。
在脓毒症患者中，EA与SCM无关。然而，多黏菌素B血液灌流清除内毒素与心肌病恢复相关，而心肌病恢复是28天死亡率降低的一个预测指标。
