Lactate predicts the 28-day survival rate in patients with septic shock treated with the combination of PMX-DHP and rTM.
catecholamine administration
disseminated intravascular coagulation
induction timing
polymyxin-B direct hemoperfusion
recombinant thrombomodulin
septic shock
Journal
Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
ISSN: 1744-9987
Titre abrégé: Ther Apher Dial
Pays: Australia
ID NLM: 101181252
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
pubmed:
12
6
2020
medline:
15
9
2021
entrez:
12
6
2020
Statut:
ppublish
Résumé
We have previously reported that combination therapy with polymyxin-B direct hemoperfusion (PMX-DHP) and recombinant thrombomodulin (rTM) is effective in patients with septic shock accompanied by disseminated intravascular coagulation (DIC). Two previous studies reporting the favorable effect of early initiation of PMX-DHP for septic shock did not focus on the combination therapy of PMX-DHP and rTM. This retrospective study included 47 consecutive patients who underwent the combination therapy of PMX-DHP and rTM for septic shock with DIC from August 2011 to August 2016. Main exposure was early or late initiation of PMX-DHP. PMX-DHP initiated within 12 hours after catecholamine administration was designated as early group (N = 25) and later than 12 hours as late group (N = 22). Main outcome was 28-day survival rate. The patient characteristics were age median 73 (IQR 68-78) years, 26 men (55%), APACHE II score 32.7 ± 7.7 and lactate 26.0 (18.0-41.0) mg/dL. The 28-day survival rate after PMX-DHP initiation was 76.6% and was not significantly different in the two groups. In the early group, APACHE II score was lower (P = .02), and lactate was higher (P = .005) than in the late group. Lactate was the only predictor of 28-day mortality [odds ratio (95%CI) per 1 mg/dL, 1.08 (1.03-1.19); P = .037] in multivariate logistic regression analysis adjusted with age, sex, APACHE II score, lactate and timing of PMX-DHP initiation. Late PMX-DHP initiation did not lead to statistically worse 28-day survival rate in this combination therapy. The combination therapy of PMX-DHP and rTM may improve the therapeutic effect of PMX-DHP and modify the effect of early PMX-DHP on the prognosis. Lactate may be an appropriate indicator rather than time after catecholamine administration if we discuss when to start PMX-DHP in this combination therapy.
Identifiants
pubmed: 32524733
doi: 10.1111/1744-9987.13544
doi:
Substances chimiques
Anti-Bacterial Agents
0
Thrombomodulin
0
Lactic Acid
33X04XA5AT
Polymyxin B
J2VZ07J96K
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
492-498Informations de copyright
© 2020 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.
Références
Yamashita C, Hara Y, Kuriyama N, Nakamura T, Nishida O. Clinical effects of a longer duration of polymyxin B-immobilized fiber column direct hemoperfusion therapy for severe sepsis and septic shock. Ther Apher Dial. 2015;19:316-323.
Cruz DN, Antonelli M, Fumagalli R, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA. 2009;301:2445-2452.
Klein DJ, Foster D, Walker PM, Bagshaw SM, Mekonnen H, Antonelli M. Polymyxin B hemoperfusion in endotoxemic septic shock patients without extreme endotoxemia: a post hoc analysis of the EUPHRATES trial. Intensive Care Med. 2018;44(12):2205-2212.
Wang Y, Liu Y, Sarker KP, et al. Polymyxin B binds to anandamide and inhibits its cytotoxic effect. FABS Lett. 2000;470:151-155.
Kobayashi M. (review) endotoxin adsorption therapy(PMX-DHP) for septic multiple organ failure. J Jpn Soc Apheresis. 2010;29:266-271.
Nishibori M, Takahashi H, Katayama H, et al. Specific removal of monocytes from peripheral blood of septic patients by polymyxin B-immobilized filter column. Acta Med Okayama. 2009;63:65-69.
Minematsu Y, Yamato M, Fujii J, et al. The effect of polymyxin B-immobilized fiber column on the removal of high mobility group box 1(HMGB1). J Jpn Soc Blood Purify Crit Care. 2013;4:128-132.
Hatada T, Wada H, Nobori T, et al. Plasma concentrations and importance of high mobility group box protein in the prognosis of organ failure in patients with disseminated intravascular coagulation. Thromb Haemost. 2005;94:975-979.
Ito T, Kawahara K, Okamoto K, et al. Proteolytic cleavage of high mobility group box 1 protein by thrombin-thrombomodulin complexes. Arterioscler Thromb Vasc Biol. 2008;28(10):1825-1830.
Yamato M, Minematsu Y, Fujii J, et al. Effective combination therapy of polymyxin-B direct hemoperfusion and recombinant thrombomodulin for septic shock accompanied by disseminated intravascular coagulation: A historical controlled trial. Ther Apher Dial. 2013;17:472-476.
Chihara S, Masuda Y, Tatsumi H, et al. Early induction of direct hemoperfusion with a polymyxin-B immobilized column is associated with amelioration of hemodynamic derangement and mortality in patients with septic shock. J Artif Organs. 2017;20(1):71-75.
Tanaka T, Tabata T, Fujino K, Tsujita Y, Eguchi Y. Impact of timing of polymyxin B-immobilized fiber column direct hemoperfusion on outcome in patients with septic shock: a single-center observational study. Acute Med Surg. 2019;7:e446. https://doi.org/10.1002/ams2.446.
Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med. 2003;31:1250-1256.
Gando S, Iba T, Eguchi Y, et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: Comparing current criteria. Crit Care Med. 2006;34:625-631.
Mitaka C, Fujiwara N, Yamamoto M, Toyofuku T, Haraguchi G, Tomita M. Polymyxin B-immobilized fiber column hemoperfusion removes endotoxin throughout a 24-hour treatment period. J Crit Care. 2014;29:728-732.
Mitaka C, Tsuchida N, Kawada K, Nakajima Y, Imai T, Sasaki S. A longer duration of polymyxin B-immobilized fiber column hemoperfusion improves pulmonary oxygenation in patients with septic shock. Shock. 2009;32:478-483.
Venet F, Monneret G. Advances in the understanding and treatment of sepsis-induced immunosuppression. Nat Rev Nephrol. 2018;14:121-137.
Shalova IN, Lim JY, Chittezhath M, et al. Human monocytes undergo functional re-programming during sepsis mediated by hypoxia-inducible factor-1alpha. Immunity. 2015;42:484-498.
Shi CS, Shi GY, Hsiao HM, et al. Lectin-like domain of thrombomodulin binds to its specific ligand Lewis Y antigen and neutralizes lipopolysaccharide-induced inflammatory response. Blood. 2008;112(9):3661-3670.