Chang Wei-Hung, Hu Ting-Yu, Kuo Li-Kuo
Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan.
Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan.
Life (Basel). 2025 Aug 20;15(8):1317. doi: 10.3390/life15081317.
: Severe sepsis and septic shock remain major contributors to ICU mortality. Polymyxin B hemoperfusion (PMX-HP) has been widely adopted as adjunctive therapy in Asian ICUs for endotoxemia, but its real-world effectiveness and prognostic factors remain uncertain, especially in high Gram-negative settings. : This retrospective cohort study included 64 adult patients with severe sepsis or septic shock who received at least one session of PMX-HP in a 25-bed tertiary medical ICU in Taiwan between July 2013 and December 2019. Demographic, clinical, microbiological, and treatment data were extracted. The primary outcome was 28-day mortality. Prognostic factors were analyzed using logistic regression. : The mean age was 66.1 ± 12.3 years; 67.2% were male. Pneumonia (29.7%) and intra-abdominal infection (18.8%) were the most common sources of sepsis, with E. coli and K. pneumoniae as leading pathogens. Median APACHE II score at ICU admission was 26 (IQR 21-32), and 79.7% received two PMX-HP sessions. The 28-day mortality rate was 46.9%, with ICU and hospital mortality both 53.1%. Non-survivors were older, had higher APACHE II scores, and more frequent use of after PMX-HP were also more common among non-survivors. Multivariate analysis identified advanced age, higher APACHE II score, and CRRT requirement as independent predictors of mortality. : In this real-world Asian ICU cohort, PMX-HP was used mainly for severe cases with a high disease burden and Gram-negative predominance. Despite its frequent use, overall mortality remained high. Prognosis was primarily determined by underlying disease severity, organ dysfunction (especially renal failure), and persistent hemodynamic instability. In this high-severity cohort, mortality appeared to be primarily driven by baseline organ dysfunction and persistent hemodynamic instability; PMX-HP session number or sequencing showed no association with survival. Given the absence of a contemporaneous non-PMX-HP control group, mortality observations in this cohort cannot be causally attributed to PMX-HP and should be interpreted with caution as hypothesis-generating rather than definitive evidence of efficacy. Further multicenter studies are needed to clarify the optimal role of PMX-HP in modern sepsis management.
严重脓毒症和脓毒性休克仍然是重症监护病房（ICU）死亡的主要原因。多粘菌素B血液灌流（PMX-HP）已在亚洲的ICU中广泛用作内毒素血症的辅助治疗，但在实际应用中的有效性和预后因素仍不确定，尤其是在革兰氏阴性菌感染高发的情况下。
这项回顾性队列研究纳入了64例成年严重脓毒症或脓毒性休克患者，这些患者于2013年7月至2019年12月期间在台湾一家拥有25张床位的三级医疗ICU接受了至少一次PMX-HP治疗。提取了人口统计学、临床、微生物学和治疗数据。主要结局是28天死亡率。使用逻辑回归分析预后因素。
平均年龄为66.1±12.3岁；67.2%为男性。肺炎（29.7%）和腹腔内感染（18.8%）是最常见的脓毒症来源，大肠杆菌和肺炎克雷伯菌是主要病原体。入住ICU时APACHE II评分中位数为26（四分位间距21 - 32），79.7%的患者接受了两次PMX-HP治疗。28天死亡率为46.9%，ICU死亡率和医院死亡率均为53.1%。非幸存者年龄更大，APACHE II评分更高，且在接受PMX-HP治疗后更频繁地使用连续性肾脏替代治疗（CRRT）在非幸存者中也更常见。多因素分析确定高龄、较高的APACHE II评分和CRRT需求是死亡率的独立预测因素。
在这个实际的亚洲ICU队列中，PMX-HP主要用于疾病负担高且以革兰氏阴性菌为主的严重病例。尽管使用频繁，但总体死亡率仍然很高。预后主要由基础疾病严重程度、器官功能障碍（尤其是肾衰竭）和持续的血流动力学不稳定决定。在这个高严重程度队列中，死亡率似乎主要由基线器官功能障碍和持续的血流动力学不稳定驱动；PMX-HP治疗次数或顺序与生存率无关。由于缺乏同期非PMX-HP对照组，该队列中的死亡率观察结果不能因果归因于PMX-HP，应谨慎解释为产生假设而非疗效的确切证据。需要进一步的多中心研究来阐明PMX-HP在现代脓毒症管理中的最佳作用。
