Impact of polymyxin B hemoperfusion therapy on high endotoxin activity level patients after successful infection source control: a prospective cohort study

• Published in: Scientific reports 2021-12, Vol.11 (1), p.24132-24132, Article 24132
• Main Authors: Lee, Won Young, Kim, Hee Ju, Kim, Eun Young
• Format: Article
• Language: English
• Subjects: 692/308; 692/499; Aged; Bacilli; Biomarkers - blood; Cohort analysis; Death; Endotoxins; Endotoxins - blood; Female; Gram-negative bacilli; Gram-Negative Bacterial Infections - blood; Gram-Negative Bacterial Infections - mortality; Gram-Negative Bacterial Infections - therapy; Hemoperfusion - methods; Hospital Mortality; Humanities and Social Sciences; Humans; Male; Middle Aged; Mortality; multidisciplinary; Patients; Polymyxin B; Polymyxin B - administration & dosage; Prospective Studies; Risk groups; Science; Science (multidisciplinary); Sepsis; Septic shock; Shock, Septic - blood; Shock, Septic - diagnosis; Shock, Septic - mortality; Shock, Septic - therapy
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-03055-8

We sought to evaluate the clinical implication of endotoxin levels in gram-negative bacilli (GNB)-induced abdominal septic shock patients with polymyxin B-hemoperfusion (PMX-HP) treatment. A prospective cohort of 60 patients who received surgical infectious source control for abdominal sepsis from January 2019 to December 2020 was included in the study. Endotoxin activity (EA) levels and Sequential Organ Failure Assessment (SOFA) scores were assessed immediately after surgery (baseline), 24, and 48 h post baseline. With receiver operating characteristic curves, the patients were stratified into two groups by the EA cut-off value (high-risk group vs low-risk group) and the clinical outcomes were compared. Logistic regression was performed to identify the clinical impact of PMX-HP on in-hospital death. Among the 31 high-risk patients (EA level ≥ 0.54), 16 patients (51.6%) received PMX-HP treatment and showed significant decreases in EA levels compared to patients who underwent conventional treatment only (− 0.34 vs − 0.12, p  = 0.01). SOFA scores also showed significant improvement with PMX-HP treatment (12.8–8.9, p  = 0.007). Fourteen in-hospital deaths occurred (45.2%), and PMX-HP treatment had a protective effect on in-hospital death (odds ratio (OR) 0.04, p  = 0.03). In 29 low-risk patients (EA level