Early initiation of polymyxin B hemoperfusion therapy for cancer patients with refractory septic shock

Abstract

AbstractPurposeIn this study, we analyzed correlations between 28-day mortality and hemodynamic changes, measured using polymyxin B-immobilized fiber column direct hemoperfusion initiation time, in patients with cancer with refractory septic shock.Materials and methodsWe retrospectively analyzed 45 patients with cancer who received polymyxin B-immobilized fiber column direct hemoperfusion due to refractory septic shock. Patients were categorized into early (<12 h between refractory septic shock and initiation of polymyxin B-immobilized fiber column direct hemoperfusion) and late (>12 h) initiation groups. Changes in vasoactive inotrope scores, sequential organ failure assessment scores, and PaO2/FiO2ratios before and 24 h after polymyxin B-immobilized fiber column direct hemoperfusion, were compared.ResultsUnivariable analysis showed that 28-day mortality risk was associated with diabetes mellitus (odds ratio=3.081; 95% confidence interval =1.290–7.360;p=0.011), lactic acid (odds ratio=1.010; 95% confidence interval =1.005– 1.014;p<0.0001), and sequential organ failure assessment score (odds ratio=1.190; 95% confidence interval =1.044–1.357;p=0.009). Multivariable analysis showed that 28-day mortality risk was associated with diabetes mellitus (odds ratio=2.718; 95% confidence interval =1.013–7.291;p=0.047), early initiation (odds ratio=0.268; 95% confidence interval =0.094–0.765;p=0.014), and lactic acid (odds ratio=1.009; 95% confidence interval =1.004– 1.014;p<0.0001). Overall survival was slightly higher in the early than in the late initiation group (p=0.0515). Comparisons of variables before and 24 h after polymyxin B-immobilized fiber column direct hemoperfusion revealed that vasoactive inotrope scores decreased in both the early and late groups (Δ318vs.Δ114;p=0.001 andp=0.005, respectively), whereas the PaO2/FiO2ratio slightly increased (Δ127.5vs.Δ95.6;p=0.350 andp=0.390, respectively) over time.ConclusionsIn patients with cancer with refractory septic shock, early initiation of polymyxin B-immobilized fiber column direct hemoperfusion reduced inotrope-vasopressor requirement and 28-day mortality.