Keywords :
Intensive care unit, Mortality, Polymyxin B, Sepsis, Sequential organ failure assessment
Citation Information :
Ghosh I, Sangha S, Pandey G, Srivastava A. Efficacy of Polymyxin B Hemoperfusion for Treatment of Sepsis. Indian J Crit Care Med 2024; 28 (10):930-934.
Objectives: To study the efficacy of polymyxin B hemoperfusion in addition to standard care for sepsis treatment.
Materials and methods: Fifty sepsis patients (mean age 54.26 ± 14.64 years; 68% males) were randomized to either the case group (n = 25; receiving Polymyxin B hemoperfusion in addition to standard ICU care) or the control group (n = 25; receiving standard ICU care only). The patients were followed up at frequent intervals of 6, 12, 24, 48, and 72 hours. A last follow-up on day 7 was done. The duration of the ICU stay and survival until day 7 were recorded. Changes in clinical and biochemical parameters were also noted and compared.
Results: Mean sequential organ failure assessment (SOFA) scores at admission were 3.44 ± 1.00 and 2.80 ± 0.82, respectively, in cases and controls. Cases as compared to controls showed faster, and sustainable improvement. No significant difference between the two groups was seen for mortality at day 7.
Conclusion: Polymyxin B hemoperfusion tends to show a faster recovery and a non-significant trend towards reduced mortality in ICU-admitted sepsis patients.
Marik PE, Raghavan M. Stress-hyperglycemia, insulin and immunomodulation in sepsis. Intensive Care Med 2004;30(5):748–756. DOI: 10.1007/s00134-004-2167-y.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29(7):1303–1310. DOI: 10.1097/00003246-200107000-00002.
Taylor JH, Beilman GJ. Hyperglycemia in the intensive care unit: No longer just a marker of illness severity. Surg Infect (Larchmt) 2005;6(2):233–245. DOI: 10.1089/sur.2005.6.233.
Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM. Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma 2005;59(1):80–83. DOI: 10.1097/01.ta.0000171452.96585.84.
Rimmelé T, Kellum JA. Clinical review: Blood purification for sepsis. Crit Care 2011;15(1):205. DOI: 10.1186/cc9411.
Govil D, Kumar GP. Extracorporeal therapy in sepsis. Indian J Crit Care Med 2020;24(Suppl 3):S117–S121. DOI: 10.5005/jp-journals-10071-23382.
Marshall JC, Foster D, Vincent JL, Cook DJ, Cohen J, Dellinger RP, et al. Diagnostic and prognostic implications of endotoxemia in critical illness: Results of the MEDIC study. J Infect Dis 2004;190(3):527–534. DOI: 10.1086/422254.
Cantaluppi V, Assenzio B, Pasero D, Romanazzi GM, Pacitti A, Lanfranco G, et al. Polymyxin-B hemoperfusion inactivates circulating proapoptotic factors. Intensive Care Med 2008;34(9):1638–1645. DOI: 10.1007/s00134-008-1124-6.
Fujimori K, Tarasawa K, Fushimi K. Effects of polymyxin B hemoperfusion on septic shock patients requiring noradrenaline: Analysis of a nationwide administrative database in Japan. Blood Purif 2021;50(4–5):560–565. DOI: 10.1159/000513213.
Dellinger RP, Bagshaw SM, Antonelli M, Foster DM, Klein DJ, Marshall JC, et al. effect of targeted polymyxin B hemoperfusion on 28-day mortality in patients with septic shock and elevated endotoxin level: The EUPHRATES randomized clinical trial. JAMA 2018;320(14):1455–1463. DOI: 10.1001/jama.2018.14618.
Kim JJ, Park YJ, Moon KY, Park JH, Jeong YK, Kim EY. Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock. World J Gastrointest Surg 2019;11(12):422–432. DOI: 10.4240/wjgs.v11.i12.422.
Cutuli SL, Artigas A, Fumagalli R, Monti G, Ranieri VM, Ronco C, et al. Polymyxin-B hemoperfusion in septic patients: Analysis of a multicenter registry. Ann Intensive Care 2016;6(1):77. DOI: 10.1186/s13613-016-0178-9.
Srisawat N, Tungsanga S, Lumlertgul N, Komaenthammasophon C, Peerapornratana S, Thamrongsat N, et al. The effect of polymyxin B hemoperfusion on modulation of human leukocyte antigen DR in severe sepsis patients. Crit Care 2018;22(1):279. DOI: 10.1186/s13054-018-2077-y.
Monti G, Terzi V, Calini A, Di Marco F, Cruz D, Pulici M, et al. Rescue therapy with polymyxin B hemoperfusion in high-dose vasopressor therapy refractory septic shock. Minerva Anestesiol 2015;81(5):516–525. PMID: 25319136.
Payen DM, Guilhot J, Launey Y, Lukaszewicz AC, Kaaki M, Veber B, et al. Early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: A multicenter randomized control trial. Intensive Care Med 2015;41(6):975–984. DOI: 10.1007/s00134-015-3751-z.
Nakata H, Yamakawa K, Kabata D, Umemura Y, Ogura H, Gando S, et al. Identifying septic shock populations benefitting from polymyxin B hemoperfusion: A prospective cohort study incorporating a restricted cubic spline regression model. Shock 2020;54(5):667–674. DOI: 10.1097/SHK.0000000000001533.
Kellum JA, Kong L, Fink MP, Weissfeld LA, Yealy DM, Pinsky MR, et al. Understanding the inflammatory cytokine response in pneumonia and sepsis: Results of the genetic and inflammatory markers of sepsis (GenIMS) study. Arch Intern Med 2007;167(15):1655–1663. DOI: 10.1001/archinte.167.15.1655.
Iwagami M, Yasunaga H, Noiri E, Horiguchi H, Fushimi K, Matsubara T, et al. Potential survival benefit of polymyxin B hemoperfusion in septic shock patients on continuous renal replacement therapy: A propensity-matched analysis. Blood Purif 2016;42(1):9–17. DOI: 10.1159/000444474.
Nakamura Y, Kitamura T, Kiyomi F, Hayakawa M, Hoshino K, Kawano Y, et al. Potential survival benefit of polymyxin B hemoperfusion in patients with septic shock: A propensity-matched cohort study. Crit Care 2017;21(1):134. DOI: 10.1186/s13054-017- 1712-3.
