Clinical implications of endotoxin activity and Polymyxin‐B hemoperfusion in critically ill patients with septic cardiomyopathy: A single‐center, retrospective, observational study

Abstract

AbstractBackgroundTo 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).MethodsObservational 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.ResultsAmong 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).ConclusionsIn 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.