{"title":"顽固性脓毒性休克患者多粘菌素B血液灌流的血流动力学反应及其临床结局：前瞻性队列研究的事后亚分析","authors":"Kyohei Miyamoto, Yu Kawazoe, Noriko Miyagawa, Hitoshi Yamamura, Yoshinori Ohta, Takuya Kimura, Yukitoshi Toyoda, Michihito Kyo, Tetsuya Sato, Masashi Kinjo, Masaki Takahashi, Junichi Maruyama, Hiroshi Matsuura, Kazunori Fukushima, Satoru Murata, Tomoya Okazaki, Tsuyoshi Suzuki, Toshihiro Sakurai, Gaku Takahashi, Tasuku Hanajima, Takeshi Morimoto","doi":"10.1097/SHK.0000000000002654","DOIUrl":null,"url":null,"abstract":"<p><strong>Abstract: </strong>Background: Polymyxin B hemoperfusion (PMX-HP) reportedly improves hemodynamic status in some but not all patients with septic shock. We examined the association between hemodynamic response and clinical outcomes and explored factors that may identify patients with hemodynamic response. Methods: BEAT-SHOCK registry is a prospective cohort study of 309 consecutive adult patients with septic shock requiring high-dose norepinephrine. This predefined subanalysis included 82 patients treated with PMX-HP. We defined hemodynamic response as a ≥ 20% improvement within 6 h of starting PMX-HP in the modified vasopressor dependency index, representing vasopressor dosage divided by mean arterial pressure. Results: The median modified vasopressor dependency index at the start of PMX-HP was 0.56 mmHg -1 , and 0.34 mmHg -1 6 h after starting PMX-HP (median relative change -32%). Hemodynamic response was obtained in 53 patients (65%; responder group). The 28-day mortality rate was 8% (4/53) in the responder group and 31% (9/29) in the nonresponder group ( P = 0.0042). Three potential factors were: lower Sequential Organ Failure Assessment score (≤10, adjusted odds ratio [aOR] 3.36), abdominal or urinary tract infection (aOR 2.49), and higher modified vasopressor dependency index at the start of PMX-HP (≥0.5 mmHg -1 , aOR 2.14). Patients with two or three factors were likely to respond to PMX-HP. Conclusions: Among patients with refractory septic shock, 65% had hemodynamic response after PMX-HP, and it was associated with better clinical outcomes, as shown by the higher survival rate. The number of the following factors was associated with the likelihood of hemodynamic response: less organ dysfunction, more vasopressors, and abdominal/urinary tract infection. Trial registration: UMIN Clinical Trial Registry on 1 November 2019 (registration no. UMIN000038302).</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"397-404"},"PeriodicalIF":2.9000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"HEMODYNAMIC RESPONSE BY POLYMYXIN B HEMOPERFUSION AND ITS CLINICAL OUTCOMES IN PATIENTS WITH REFRACTORY SEPTIC SHOCK: A POST-HOC SUBANALYSIS OF PROSPECTIVE COHORT STUDY.\",\"authors\":\"Kyohei Miyamoto, Yu Kawazoe, Noriko Miyagawa, Hitoshi Yamamura, Yoshinori Ohta, Takuya Kimura, Yukitoshi Toyoda, Michihito Kyo, Tetsuya Sato, Masashi Kinjo, Masaki Takahashi, Junichi Maruyama, Hiroshi Matsuura, Kazunori Fukushima, Satoru Murata, Tomoya Okazaki, Tsuyoshi Suzuki, Toshihiro Sakurai, Gaku Takahashi, Tasuku Hanajima, Takeshi Morimoto\",\"doi\":\"10.1097/SHK.0000000000002654\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Abstract: </strong>Background: Polymyxin B hemoperfusion (PMX-HP) reportedly improves hemodynamic status in some but not all patients with septic shock. We examined the association between hemodynamic response and clinical outcomes and explored factors that may identify patients with hemodynamic response. Methods: BEAT-SHOCK registry is a prospective cohort study of 309 consecutive adult patients with septic shock requiring high-dose norepinephrine. This predefined subanalysis included 82 patients treated with PMX-HP. We defined hemodynamic response as a ≥ 20% improvement within 6 h of starting PMX-HP in the modified vasopressor dependency index, representing vasopressor dosage divided by mean arterial pressure. Results: The median modified vasopressor dependency index at the start of PMX-HP was 0.56 mmHg -1 , and 0.34 mmHg -1 6 h after starting PMX-HP (median relative change -32%). Hemodynamic response was obtained in 53 patients (65%; responder group). The 28-day mortality rate was 8% (4/53) in the responder group and 31% (9/29) in the nonresponder group ( P = 0.0042). Three potential factors were: lower Sequential Organ Failure Assessment score (≤10, adjusted odds ratio [aOR] 3.36), abdominal or urinary tract infection (aOR 2.49), and higher modified vasopressor dependency index at the start of PMX-HP (≥0.5 mmHg -1 , aOR 2.14). Patients with two or three factors were likely to respond to PMX-HP. Conclusions: Among patients with refractory septic shock, 65% had hemodynamic response after PMX-HP, and it was associated with better clinical outcomes, as shown by the higher survival rate. The number of the following factors was associated with the likelihood of hemodynamic response: less organ dysfunction, more vasopressors, and abdominal/urinary tract infection. Trial registration: UMIN Clinical Trial Registry on 1 November 2019 (registration no. UMIN000038302).</p>\",\"PeriodicalId\":21667,\"journal\":{\"name\":\"SHOCK\",\"volume\":\" \",\"pages\":\"397-404\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"SHOCK\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/SHK.0000000000002654\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"SHOCK","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SHK.0000000000002654","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/17 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
HEMODYNAMIC RESPONSE BY POLYMYXIN B HEMOPERFUSION AND ITS CLINICAL OUTCOMES IN PATIENTS WITH REFRACTORY SEPTIC SHOCK: A POST-HOC SUBANALYSIS OF PROSPECTIVE COHORT STUDY.
Abstract: Background: Polymyxin B hemoperfusion (PMX-HP) reportedly improves hemodynamic status in some but not all patients with septic shock. We examined the association between hemodynamic response and clinical outcomes and explored factors that may identify patients with hemodynamic response. Methods: BEAT-SHOCK registry is a prospective cohort study of 309 consecutive adult patients with septic shock requiring high-dose norepinephrine. This predefined subanalysis included 82 patients treated with PMX-HP. We defined hemodynamic response as a ≥ 20% improvement within 6 h of starting PMX-HP in the modified vasopressor dependency index, representing vasopressor dosage divided by mean arterial pressure. Results: The median modified vasopressor dependency index at the start of PMX-HP was 0.56 mmHg -1 , and 0.34 mmHg -1 6 h after starting PMX-HP (median relative change -32%). Hemodynamic response was obtained in 53 patients (65%; responder group). The 28-day mortality rate was 8% (4/53) in the responder group and 31% (9/29) in the nonresponder group ( P = 0.0042). Three potential factors were: lower Sequential Organ Failure Assessment score (≤10, adjusted odds ratio [aOR] 3.36), abdominal or urinary tract infection (aOR 2.49), and higher modified vasopressor dependency index at the start of PMX-HP (≥0.5 mmHg -1 , aOR 2.14). Patients with two or three factors were likely to respond to PMX-HP. Conclusions: Among patients with refractory septic shock, 65% had hemodynamic response after PMX-HP, and it was associated with better clinical outcomes, as shown by the higher survival rate. The number of the following factors was associated with the likelihood of hemodynamic response: less organ dysfunction, more vasopressors, and abdominal/urinary tract infection. Trial registration: UMIN Clinical Trial Registry on 1 November 2019 (registration no. UMIN000038302).
期刊介绍：
SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.
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