Miyamoto Kyohei, Kawazoe Yu, Miyagawa Noriko, Yamamura Hitoshi, Ohta Yoshinori, Kimura Takuya, Toyoda Yukitoshi, Kyo Michihito, Sato Tetsuya, Kinjo Masashi, Takahashi Masaki, Maruyama Junichi, Matsuura Hiroshi, Fukushima Kazunori, Murata Satoru, Okazaki Tomoya, Suzuki Tsuyoshi, Sakurai Toshihiro, Takahashi Gaku, Hanajima Tasuku, Morimoto Takeshi
Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
Department of Emergency and Critical Care Medicine, National Hospital Organization Sendai Medical Center, Sendai, Japan.
Crit Care. 2025 May 9;29(1):187. doi: 10.1186/s13054-025-05422-7.
Delayed administration of polymyxin B hemoperfusion (PMX-HP) for septic shock could diminish its efficacy in real-world clinical settings.
BEAT-SHOCK (BEst Available Treatment for septic SHOCK) registry is a prospective registry consisting of 309 adult patients with septic shock requiring high-dose norepinephrine (≥ 0.2 μg/kg/min). This predetermined analysis included 82 patients treated with PMX-HP. They were grouped according to the median time from intensive care unit (ICU) admission to administration of PMX-HP: the early administration group (n = 40) and the late administration group (n = 42). The primary outcome was short-term hemodynamic status, including mean arterial pressure and vasoactive-inotropic score (VIS; calculated from doses of dopamine, dobutamine, norepinephrine, epinephrine, vasopressin, milrinone, and levosimendan) within 48 h after ICU admission.
The median time from ICU admission to administration of PMX-HP was 265 min (interquartile range [IQR]: 113-480). The median ages were 70 (IQR: 59-81) and 72 (IQR: 64-80) years (P = 0.77), and 21/40 (53%) and 25/42 (60%) patients were male (P = 0.52) in the early and late administration groups, respectively. The dose of norepinephrine at ICU admission was 0.33 (IQR: 0.24-0.47) and 0.30 (IQR: 0.22-0.34) μg/kg/min in the early and late administration groups, respectively (P = 0.17). Within 48 h after ICU admission, mean arterial pressure was significantly higher at 6 h and 8 h, and VIS was significantly lower at 8 h and thereafter in the early administration group. Within a 28-day period, there were 23 (IQR: 21-25) and 21 (IQR: 0-24) vasopressor/inotrope-free days (P = 0.027), and 18 (IQR: 1-23) and 14 (IQR: 0-19) ICU-free days (P = 0.025) in the early and late administration groups, respectively. The cumulative mortality at 90 days was 15.3% in the early administration group and 31.3% in the late administration group (adjusted hazard ratio 0.38; 95% confidence interval 0.13-1.09).
In patients with septic shock, early administration of PMX-HP was associated with higher mean arterial pressure and lower VIS within 48 h after ICU admission. Additionally, it may be associated with an improved clinical course, represented by more ICU-free and vasopressor/inotrope-free days. Trial registration UMIN Clinical Trial Registry on 1 November 2019 (registration no. UMIN000038302).
脓毒性休克患者延迟进行多粘菌素B血液灌流（PMX-HP）治疗可能会降低其在实际临床环境中的疗效。
BEAT-SHOCK（脓毒性休克最佳可用治疗）登记研究是一项前瞻性登记研究，纳入了309例需要大剂量去甲肾上腺素（≥0.2μg/kg/min）治疗的成年脓毒性休克患者。这项预先设定的分析纳入了82例接受PMX-HP治疗的患者。根据从重症监护病房（ICU）入院到开始PMX-HP治疗的中位时间将他们分组：早期治疗组（n = 40）和晚期治疗组（n = 42）。主要结局是短期血流动力学状态，包括ICU入院后48小时内的平均动脉压和血管活性药物-正性肌力药物评分（VIS；根据多巴胺、多巴酚丁胺、去甲肾上腺素、肾上腺素、血管加压素、米力农和左西孟旦的剂量计算）。
从ICU入院到开始PMX-HP治疗的中位时间为265分钟（四分位数间距[IQR]：113 - 480）。早期治疗组和晚期治疗组的中位年龄分别为70岁（IQR：59 - 81）和72岁（IQR：64 - 80）（P = 0.77），男性患者分别为21/40（53%）和25/42（60%）（P = 0.52）。ICU入院时去甲肾上腺素的剂量在早期治疗组和晚期治疗组分别为0.33（IQR：0.24 - 0.47）和0.30（IQR：0.22 - 0.34）μg/kg/min（P = 0.17）。在ICU入院后48小时内，早期治疗组在6小时和8小时时的平均动脉压显著更高，在8小时及之后VIS显著更低。在28天内，早期治疗组和晚期治疗组分别有23天（IQR：21 - 25）和21天（IQR：0 - 24）无需使用血管加压药/正性肌力药物（P = 0.027），以及18天（IQR：1 - 23）和14天（IQR：0 - 19）无需入住ICU（P = 0.025）。90天时的累积死亡率在早期治疗组为15.3%，在晚期治疗组为31.3%（校正风险比0.38；95%置信区间0.13 - 1.09）。
在脓毒性休克患者中，早期进行PMX-HP治疗与ICU入院后48小时内更高的平均动脉压和更低的VIS相关。此外还可能与临床病程改善有关，表现为无需入住ICU和无需使用血管加压药/正性肌力药物的天数增多。试验注册于2019年11月1日在UMIN临床试验注册中心注册（注册号UMIN000038302）。
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