Lactate predicts the 28‐day survival rate in patients with septic shock treated with the combination of PMX‐DHP and rTM

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.