Direct hemoperfusion using polymyxin-B immobilized fiber for severe septic patients with hematological disorders: A single-center analysis

Abstract The benefit of endotoxin absorption therapy (direct hemoperfusion with polymyxin B-immobilized fiber: PMX-DHP) for severe septic patients is still controversial. There are limited data on the clinical experience and efficacy of PMX-DHP for septic patients with hematological disorders. At our institution, 16 patients with hematological diseases underwent PMX-DHP therapy for gram-negative septic shock from February 2006 to March 2012. Most of the patients had severe neutropenia (median neutrophil counts: 7/μL) due to intensive chemotherapy for their hematological diseases. After the PMX-DHP therapy, six patients recovered from the shock status (favorable group) and ten died of the sepsis (unfavorable group). We analyzed the differences between the two groups based on clinical characteristics just before PMX-DHP therapy. Regarding sequential organ failure assessment (SOFA) score, which is a scoring system to determine the degree of organ dysfunction, all patients in the favorable group scored less than 11. The sensitivity and specificity of SOFA score less than 11 for the therapeutic efficacy were 100% and 80%, respectively. Our results suggest that septic patients with hematological diseases may not be a candidate for PMX-DHP therapy when they have already developed serious organ dysfunction.