Lee Jae Hoon, Han Won Ho, Im Hyun-Jae, Kim Jee Hee
Critical Care Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Republic of Korea.
Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu 11759, Republic of Korea.
J Clin Med. 2024 Feb 9;13(4):1009. doi: 10.3390/jcm13041009.
: We aimed to analyze the correlation between in-hospital mortality and hemodynamic changes, using polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) initiation time in patients with cancer with refractory septic shock. : Forty-six patients with cancer who received PMX-DHP for refractory septic shock were retrospectively analyzed and classified into early (≤3 h between refractory septic shock and PMX-DHP; = 17) and late (>3 h; = 29) initiation groups. The vasopressor inotropic score (), sequential organ failure assessment (SOFA) score, and lactate clearance before and 24 h post-PMX-DHP were compared. : Overall, 52.17% died from multiple organ dysfunction, with a lower mortality rate in the early initiation group. The and SOFA score decreased in both groups, but the magnitude of decrease was not significant. Lactate clearance improved in both groups, with greater improvement in the early initiation group. Univariable analysis identified associations of in-hospital mortality with early initiation, ΔC-reactive protein, lactate clearance, ΔSOFA score, and Δ. Multivariable analysis demonstrated associations of in-hospital mortality risk with ΔSOFA score and early PMX-DHP initiation. Overall survival was higher in the early initiation group. Early initiation of PMX-DHP in patients with cancer with refractory septic shock reduced in-hospital mortality and improved lactate clearance.
我们旨在分析癌症合并难治性感染性休克患者使用多黏菌素B固定化纤维柱直接血液灌流（PMX-DHP）的起始时间与院内死亡率和血流动力学变化之间的相关性。对46例因难治性感染性休克接受PMX-DHP治疗的癌症患者进行回顾性分析，并分为早期起始组（难治性感染性休克与PMX-DHP之间间隔≤3小时；n = 17）和晚期起始组（>3小时；n = 29）。比较了PMX-DHP治疗前及治疗后24小时的血管活性药物肌力评分（VIS）、序贯器官衰竭评估（SOFA）评分和乳酸清除率。总体而言，52.17%的患者死于多器官功能障碍，早期起始组的死亡率较低。两组的VIS和SOFA评分均下降，但下降幅度不显著。两组的乳酸清除率均有所改善，早期起始组改善更为明显。单因素分析确定院内死亡率与早期起始、C反应蛋白变化值（ΔC反应蛋白）、乳酸清除率、SOFA评分变化值（ΔSOFA评分）和VIS变化值（ΔVIS）相关。多因素分析表明，院内死亡风险与ΔSOFA评分和早期PMX-DHP起始相关。早期起始组的总生存率更高。癌症合并难治性感染性休克患者早期起始PMX-DHP可降低院内死亡率并改善乳酸清除率。
