多黏菌素 B 血液灌流治疗脓毒性休克患者：一项多中心、前瞻性、观察性研究。

Endotoxin activity trend and multi-organ dysfunction in critically ill patients with septic shock, who received Polymyxin-B hemadsorption: A multicenter, prospective, observational study.

机构信息

Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.

出版信息

Artif Organs. 2023 Aug;47(8):1361-1370. doi: 10.1111/aor.14534. Epub 2023 Apr 27.

DOI:10.1111/aor.14534

PMID:37767775

Abstract

BACKGROUND

The baseline endotoxin activity (EA) may predict the outcome of critically ill septic patients who receive Polymyxin-B hemadsorption (PMX-HA), however, the clinical implications of specific EA trends remain unknown.

METHODS

Subgroup analysis of the prospective, multicenter, observational study EUPHAS2. We included 50 critically ill patients with septic shock and EA ≥ 0.6, who received PMX-HA. The primary outcome of the study was the EA and SOFA score progression from T to 120 h afterwards (T). Secondary outcomes included the EA and SOFA score progression in whom had EA at 48 h (EA) < 0.6 (EA responders, EA-R) versus who had not (EA non-responders, EA-NR).

RESULTS

Septic shock was mainly caused by 27 abdominal (54%) and 17 pulmonary (34%) infections, predominantly due to Gram negative bacteria (39 patients, 78%). The SAPS II score was 67.5 [52.8-82.3] and predicted a mortality rate of 75%. Between T and T, the EA decreased (p < 0.001), while the SOFA score and the Inotropic Score (IS) improved (p < 0.001). In comparison with EA-NR (18 patients, 47%), the EA-R group (23 patients, 53%) showed faster IS improvement and lower requirement of continuous renal replacement therapy (CRRT) during the ICU stay. Overall hospital mortality occurred in 18 patients (36%).

CONCLUSIONS

In critically ill patients with septic shock and EA ≥ 0.6 who received PMX-HA, EA decreased and SOFA score improved over 120 h. In whom high EA resolved within 48 h, IS improvement was faster and CRRT requirement was lower compared with patients with EA ≥ 0.6.

摘要

背景

基线内毒素活性（EA）可预测接受多黏菌素 B 血液吸附（PMX-HA）的危重症脓毒症患者的结局，但特定 EA 趋势的临床意义尚不清楚。

方法

对前瞻性、多中心、观察性研究 EUPHAS2 的亚组分析。我们纳入了 50 例 EA≥0.6 的脓毒性休克患者，这些患者接受了 PMX-HA 治疗。该研究的主要结局是从 T 到 120 小时后 EA 和 SOFA 评分的进展（T）。次要结局包括 EA 在 48 小时（EA）<0.6 的患者（EA 应答者，EA-R）与 EA 未<0.6 的患者（EA 无应答者，EA-NR）的 EA 和 SOFA 评分的进展。

结果

脓毒性休克主要由 27 例腹部（54%）和 17 例肺部（34%）感染引起，主要由革兰氏阴性菌引起（39 例，78%）。SAPS II 评分为 67.5[52.8-82.3]，预测死亡率为 75%。在 T 到 T 之间，EA 降低（p<0.001），而 SOFA 评分和正性肌力评分（IS）改善（p<0.001）。与 EA-NR（18 例，47%）相比，EA-R 组（23 例，53%）在 ICU 期间的 IS 改善更快，需要持续肾脏替代治疗（CRRT）的比例更低。总住院死亡率为 18 例（36%）。