The polymyxin‐B direct hemoperfusion OPTimal Initiation timing with Catecholamine PMX‐OPTIC study: A multicenter retrospective observational study
Background Polymyxin‐B direct hemoperfusion (PMX‐DHP) is an endotoxin adsorption column‐based blood purification therapy. Since one of the most potent effects of PMX‐DHP is blood pressure elevations, it may be the most effective when it is introduced at the time when the need for vasopressors is the...
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| creator | Nakamura, Kensuke Okazaki, Tetsuya Tampo, Akihito Mochizuki, Katsunori Kanda, Naoki Ono, Takahiro Yanagita, Kunio Shimomura, Taro Murase, Taichi Saito, Ken Hirayama, Takahiro Ito, Tomoaki Ogawa, Koji Nakamura, Mizuki Oda, Tomohiro Morishima, Takeshi Fukushima, Takuma Yasui, Hiroharu Akashi, Naoki Oshima, Kojiro Kawarazaki, Hiroo Akiba, Tsukasa Uemura, Susumu Honma, Yuhei Nitta, Kenichi Okamoto, Koji Takaki, Shunsuke Takeda, Hirotaka Yamashita, Chizuru |
| description | Background
Polymyxin‐B direct hemoperfusion (PMX‐DHP) is an endotoxin adsorption column‐based blood purification therapy. Since one of the most potent effects of PMX‐DHP is blood pressure elevations, it may be the most effective when it is introduced at the time when the need for vasopressors is the greatest, which, in turn, may reduce mortality.
Methods
A multicenter retrospective study was conducted at 24 ICUs in Japan. In each ICU, the 20 most recent consecutive cases of septic shock treated with PMX‐DHP were analyzed. The duration between the time of the peak vasopressive agent dose, expressed as the noradrenaline equivalent dose (NEq), and the time of PMX initiation was evaluated. The primary outcome was 28‐day mortality, and a multivariable analysis was performed to investigate factors associated with mortality.
Results
A total of 480 septic shock patients were included in the analysis. Among all patients, the 28‐day mortality group was older, more severely ill, and had a higher body mass index. The NEq peak and NEq on PMX‐DHP initiation were both higher in deceased patients. Regarding the timing of PMX‐DHP initiation from the NEq peak, −4 |
| doi_str_mv | 10.1111/aor.14865 |
| format | Article |
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Polymyxin‐B direct hemoperfusion (PMX‐DHP) is an endotoxin adsorption column‐based blood purification therapy. Since one of the most potent effects of PMX‐DHP is blood pressure elevations, it may be the most effective when it is introduced at the time when the need for vasopressors is the greatest, which, in turn, may reduce mortality.
Methods
A multicenter retrospective study was conducted at 24 ICUs in Japan. In each ICU, the 20 most recent consecutive cases of septic shock treated with PMX‐DHP were analyzed. The duration between the time of the peak vasopressive agent dose, expressed as the noradrenaline equivalent dose (NEq), and the time of PMX initiation was evaluated. The primary outcome was 28‐day mortality, and a multivariable analysis was performed to investigate factors associated with mortality.
Results
A total of 480 septic shock patients were included in the analysis. Among all patients, the 28‐day mortality group was older, more severely ill, and had a higher body mass index. The NEq peak and NEq on PMX‐DHP initiation were both higher in deceased patients. Regarding the timing of PMX‐DHP initiation from the NEq peak, −4 << 4 h had more survivors (229/304, 75.3%) than ≤−4 h (50/75, 66.7%) and ≥4 h (66/101, 65.4%) (p = 0.085). When −4 << 4 h was assigned as a reference, the timing of PMX‐DHP initiation from the NEq peak of ≤−4 h had an odds ratio of 1.96 (1.07–3.58), p = 0.029, while ≥4 h had an odds ratio of 1.64 (0.94–2.87), p = 0.082 for 28‐day mortality, in the multivariable regression analysis. A spline curve of the relationship between the probability of death and the timing of PMX‐DHP initiation from the NEq peak showed a downward convex curve with a nadir at timing = 0. The odds ratios of the timing of PMX‐DHP initiation other than −4 << 4 h were significantly higher in an older age, male sex, lower BMI, more severe illness, and higher oxygenation.
Conclusions
The induction of PMX‐DHP at the time of the peak vasopressor dose correlated with lower mortality. PMX‐DHP is one of the options available for elevating blood pressure in septic shock, and its initiation either too early or late for shock peak may not improve the outcome.
The timing of PMX‐DHP initiation from the vasopressor peak was one of the important factors to have an impact on mortality. PMX‐DHP would be one of the options available for elevating blood pressure in septic shock, and its inappropriate initiation may not improve the outcome.]]></description><identifier>ISSN: 0160-564X</identifier><identifier>ISSN: 1525-1594</identifier><identifier>EISSN: 1525-1594</identifier><identifier>DOI: 10.1111/aor.14865</identifier><identifier>PMID: 39291793</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Blood pressure ; blood purification ; Body mass index ; Body size ; Catecholamine ; Catecholamines ; Endotoxins ; Female ; Hemoperfusion ; Hemoperfusion - methods ; hemo‐absorption ; Humans ; Intensive Care Units ; Japan - epidemiology ; Male ; Middle Aged ; Mortality ; Noradrenaline ; Norepinephrine ; Observational studies ; Oxygenation ; PMX‐DHP ; Polymyxin B - administration & dosage ; Polymyxin B - therapeutic use ; Pressure effects ; Regression analysis ; Retrospective Studies ; Sepsis ; Septic shock ; Shock, Septic - mortality ; Shock, Septic - therapy ; Spline functions ; Statistical analysis ; Time Factors ; Treatment Outcome ; Vasoconstrictor Agents - administration & dosage ; Vasoconstrictor Agents - therapeutic use</subject><ispartof>Artificial organs, 2025-02, Vol.49 (2), p.218-228</ispartof><rights>2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.</rights><rights>Copyright © 2025 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2435-4f7533d504e53b866bad256f016eddfd5346b37fb375a9706947cb96fe1a0a173</cites><orcidid>0000-0001-8481-0294</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faor.14865$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faor.14865$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39291793$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nakamura, Kensuke</creatorcontrib><creatorcontrib>Okazaki, Tetsuya</creatorcontrib><creatorcontrib>Tampo, Akihito</creatorcontrib><creatorcontrib>Mochizuki, Katsunori</creatorcontrib><creatorcontrib>Kanda, Naoki</creatorcontrib><creatorcontrib>Ono, Takahiro</creatorcontrib><creatorcontrib>Yanagita, Kunio</creatorcontrib><creatorcontrib>Shimomura, Taro</creatorcontrib><creatorcontrib>Murase, Taichi</creatorcontrib><creatorcontrib>Saito, Ken</creatorcontrib><creatorcontrib>Hirayama, Takahiro</creatorcontrib><creatorcontrib>Ito, Tomoaki</creatorcontrib><creatorcontrib>Ogawa, Koji</creatorcontrib><creatorcontrib>Nakamura, Mizuki</creatorcontrib><creatorcontrib>Oda, Tomohiro</creatorcontrib><creatorcontrib>Morishima, Takeshi</creatorcontrib><creatorcontrib>Fukushima, Takuma</creatorcontrib><creatorcontrib>Yasui, Hiroharu</creatorcontrib><creatorcontrib>Akashi, Naoki</creatorcontrib><creatorcontrib>Oshima, Kojiro</creatorcontrib><creatorcontrib>Kawarazaki, Hiroo</creatorcontrib><creatorcontrib>Akiba, Tsukasa</creatorcontrib><creatorcontrib>Uemura, Susumu</creatorcontrib><creatorcontrib>Honma, Yuhei</creatorcontrib><creatorcontrib>Nitta, Kenichi</creatorcontrib><creatorcontrib>Okamoto, Koji</creatorcontrib><creatorcontrib>Takaki, Shunsuke</creatorcontrib><creatorcontrib>Takeda, Hirotaka</creatorcontrib><creatorcontrib>Yamashita, Chizuru</creatorcontrib><title>The polymyxin‐B direct hemoperfusion OPTimal Initiation timing with Catecholamine PMX‐OPTIC study: A multicenter retrospective observational study</title><title>Artificial organs</title><addtitle>Artif Organs</addtitle><description><![CDATA[Background
Polymyxin‐B direct hemoperfusion (PMX‐DHP) is an endotoxin adsorption column‐based blood purification therapy. Since one of the most potent effects of PMX‐DHP is blood pressure elevations, it may be the most effective when it is introduced at the time when the need for vasopressors is the greatest, which, in turn, may reduce mortality.
Methods
A multicenter retrospective study was conducted at 24 ICUs in Japan. In each ICU, the 20 most recent consecutive cases of septic shock treated with PMX‐DHP were analyzed. The duration between the time of the peak vasopressive agent dose, expressed as the noradrenaline equivalent dose (NEq), and the time of PMX initiation was evaluated. The primary outcome was 28‐day mortality, and a multivariable analysis was performed to investigate factors associated with mortality.
Results
A total of 480 septic shock patients were included in the analysis. Among all patients, the 28‐day mortality group was older, more severely ill, and had a higher body mass index. The NEq peak and NEq on PMX‐DHP initiation were both higher in deceased patients. Regarding the timing of PMX‐DHP initiation from the NEq peak, −4 << 4 h had more survivors (229/304, 75.3%) than ≤−4 h (50/75, 66.7%) and ≥4 h (66/101, 65.4%) (p = 0.085). When −4 << 4 h was assigned as a reference, the timing of PMX‐DHP initiation from the NEq peak of ≤−4 h had an odds ratio of 1.96 (1.07–3.58), p = 0.029, while ≥4 h had an odds ratio of 1.64 (0.94–2.87), p = 0.082 for 28‐day mortality, in the multivariable regression analysis. A spline curve of the relationship between the probability of death and the timing of PMX‐DHP initiation from the NEq peak showed a downward convex curve with a nadir at timing = 0. The odds ratios of the timing of PMX‐DHP initiation other than −4 << 4 h were significantly higher in an older age, male sex, lower BMI, more severe illness, and higher oxygenation.
Conclusions
The induction of PMX‐DHP at the time of the peak vasopressor dose correlated with lower mortality. PMX‐DHP is one of the options available for elevating blood pressure in septic shock, and its initiation either too early or late for shock peak may not improve the outcome.
The timing of PMX‐DHP initiation from the vasopressor peak was one of the important factors to have an impact on mortality. PMX‐DHP would be one of the options available for elevating blood pressure in septic shock, and its inappropriate initiation may not improve the outcome.]]></description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Blood pressure</subject><subject>blood purification</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Catecholamine</subject><subject>Catecholamines</subject><subject>Endotoxins</subject><subject>Female</subject><subject>Hemoperfusion</subject><subject>Hemoperfusion - methods</subject><subject>hemo‐absorption</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Japan - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Noradrenaline</subject><subject>Norepinephrine</subject><subject>Observational studies</subject><subject>Oxygenation</subject><subject>PMX‐DHP</subject><subject>Polymyxin B - administration & dosage</subject><subject>Polymyxin B - therapeutic use</subject><subject>Pressure effects</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Septic shock</subject><subject>Shock, Septic - mortality</subject><subject>Shock, Septic - therapy</subject><subject>Spline functions</subject><subject>Statistical analysis</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vasoconstrictor Agents - administration & dosage</subject><subject>Vasoconstrictor Agents - therapeutic use</subject><issn>0160-564X</issn><issn>1525-1594</issn><issn>1525-1594</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1q3DAURkVpSaZJFn2BIuimXTiRrL9xd9OhSQYSJpQpZGdk-7qjYFuOJCf1Lo_QVR8wTxLNTNpFIAIhuBydq6sPoQ-UHNO4TrR1x5RPpXiDJlSkIqEi42_RhFBJEiH59T567_0NIURxIvfQPsvSjKqMTdDf1Rpwb5uxHX-b7vHhzzdcGQdlwGtobQ-uHryxHV5erUyrG7zoTDA6bErBtKb7he9NWOO5DlCubaNjCfDV5XU0xSuLOfZhqMaveIbboQmmhC6Aww6Cs76PbcwdYFt4cHdbaeywvXCI3tW68XD0fB6gn6ffV_Pz5GJ5tpjPLpIy5UwkvFaCsUoQDoIVUykLXaVC1nFwqKq6EozLgqk6bqEzRWTGVVlksgaqiaaKHaDPO2_v7O0APuSt8SU0je7ADj5nlEguaao26KcX6I0dXHzxhhIqI-k0ZZH6sqPKOKB3UOe9ix_nxpySfBNWHsPKt2FF9uOzcShaqP6T_9KJwMkOuDcNjK-b8tnyx075BKORok0</recordid><startdate>202502</startdate><enddate>202502</enddate><creator>Nakamura, Kensuke</creator><creator>Okazaki, Tetsuya</creator><creator>Tampo, Akihito</creator><creator>Mochizuki, Katsunori</creator><creator>Kanda, Naoki</creator><creator>Ono, Takahiro</creator><creator>Yanagita, Kunio</creator><creator>Shimomura, Taro</creator><creator>Murase, Taichi</creator><creator>Saito, Ken</creator><creator>Hirayama, Takahiro</creator><creator>Ito, Tomoaki</creator><creator>Ogawa, Koji</creator><creator>Nakamura, Mizuki</creator><creator>Oda, Tomohiro</creator><creator>Morishima, Takeshi</creator><creator>Fukushima, Takuma</creator><creator>Yasui, Hiroharu</creator><creator>Akashi, Naoki</creator><creator>Oshima, Kojiro</creator><creator>Kawarazaki, Hiroo</creator><creator>Akiba, Tsukasa</creator><creator>Uemura, Susumu</creator><creator>Honma, Yuhei</creator><creator>Nitta, Kenichi</creator><creator>Okamoto, Koji</creator><creator>Takaki, Shunsuke</creator><creator>Takeda, Hirotaka</creator><creator>Yamashita, Chizuru</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8481-0294</orcidid></search><sort><creationdate>202502</creationdate><title>The polymyxin‐B direct hemoperfusion OPTimal Initiation timing with Catecholamine PMX‐OPTIC study: A multicenter retrospective observational study</title><author>Nakamura, Kensuke ; Okazaki, Tetsuya ; Tampo, Akihito ; Mochizuki, Katsunori ; Kanda, Naoki ; Ono, Takahiro ; Yanagita, Kunio ; Shimomura, Taro ; Murase, Taichi ; Saito, Ken ; Hirayama, Takahiro ; Ito, Tomoaki ; Ogawa, Koji ; Nakamura, Mizuki ; Oda, Tomohiro ; Morishima, Takeshi ; Fukushima, Takuma ; Yasui, Hiroharu ; Akashi, Naoki ; Oshima, Kojiro ; Kawarazaki, Hiroo ; Akiba, Tsukasa ; Uemura, Susumu ; Honma, Yuhei ; Nitta, Kenichi ; Okamoto, Koji ; Takaki, Shunsuke ; Takeda, Hirotaka ; Yamashita, Chizuru</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2435-4f7533d504e53b866bad256f016eddfd5346b37fb375a9706947cb96fe1a0a173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Blood pressure</topic><topic>blood purification</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Catecholamine</topic><topic>Catecholamines</topic><topic>Endotoxins</topic><topic>Female</topic><topic>Hemoperfusion</topic><topic>Hemoperfusion - methods</topic><topic>hemo‐absorption</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Japan - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Noradrenaline</topic><topic>Norepinephrine</topic><topic>Observational studies</topic><topic>Oxygenation</topic><topic>PMX‐DHP</topic><topic>Polymyxin B - administration & dosage</topic><topic>Polymyxin B - therapeutic use</topic><topic>Pressure effects</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Sepsis</topic><topic>Septic shock</topic><topic>Shock, Septic - mortality</topic><topic>Shock, Septic - therapy</topic><topic>Spline functions</topic><topic>Statistical analysis</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vasoconstrictor Agents - administration & dosage</topic><topic>Vasoconstrictor Agents - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nakamura, Kensuke</creatorcontrib><creatorcontrib>Okazaki, Tetsuya</creatorcontrib><creatorcontrib>Tampo, Akihito</creatorcontrib><creatorcontrib>Mochizuki, Katsunori</creatorcontrib><creatorcontrib>Kanda, Naoki</creatorcontrib><creatorcontrib>Ono, Takahiro</creatorcontrib><creatorcontrib>Yanagita, Kunio</creatorcontrib><creatorcontrib>Shimomura, Taro</creatorcontrib><creatorcontrib>Murase, Taichi</creatorcontrib><creatorcontrib>Saito, Ken</creatorcontrib><creatorcontrib>Hirayama, Takahiro</creatorcontrib><creatorcontrib>Ito, Tomoaki</creatorcontrib><creatorcontrib>Ogawa, Koji</creatorcontrib><creatorcontrib>Nakamura, Mizuki</creatorcontrib><creatorcontrib>Oda, Tomohiro</creatorcontrib><creatorcontrib>Morishima, Takeshi</creatorcontrib><creatorcontrib>Fukushima, Takuma</creatorcontrib><creatorcontrib>Yasui, Hiroharu</creatorcontrib><creatorcontrib>Akashi, Naoki</creatorcontrib><creatorcontrib>Oshima, Kojiro</creatorcontrib><creatorcontrib>Kawarazaki, Hiroo</creatorcontrib><creatorcontrib>Akiba, Tsukasa</creatorcontrib><creatorcontrib>Uemura, Susumu</creatorcontrib><creatorcontrib>Honma, Yuhei</creatorcontrib><creatorcontrib>Nitta, Kenichi</creatorcontrib><creatorcontrib>Okamoto, Koji</creatorcontrib><creatorcontrib>Takaki, Shunsuke</creatorcontrib><creatorcontrib>Takeda, Hirotaka</creatorcontrib><creatorcontrib>Yamashita, Chizuru</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nakamura, Kensuke</au><au>Okazaki, Tetsuya</au><au>Tampo, Akihito</au><au>Mochizuki, Katsunori</au><au>Kanda, Naoki</au><au>Ono, Takahiro</au><au>Yanagita, Kunio</au><au>Shimomura, Taro</au><au>Murase, Taichi</au><au>Saito, Ken</au><au>Hirayama, Takahiro</au><au>Ito, Tomoaki</au><au>Ogawa, Koji</au><au>Nakamura, Mizuki</au><au>Oda, Tomohiro</au><au>Morishima, Takeshi</au><au>Fukushima, Takuma</au><au>Yasui, Hiroharu</au><au>Akashi, Naoki</au><au>Oshima, Kojiro</au><au>Kawarazaki, Hiroo</au><au>Akiba, Tsukasa</au><au>Uemura, Susumu</au><au>Honma, Yuhei</au><au>Nitta, Kenichi</au><au>Okamoto, Koji</au><au>Takaki, Shunsuke</au><au>Takeda, Hirotaka</au><au>Yamashita, Chizuru</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The polymyxin‐B direct hemoperfusion OPTimal Initiation timing with Catecholamine PMX‐OPTIC study: A multicenter retrospective observational study</atitle><jtitle>Artificial organs</jtitle><addtitle>Artif Organs</addtitle><date>2025-02</date><risdate>2025</risdate><volume>49</volume><issue>2</issue><spage>218</spage><epage>228</epage><pages>218-228</pages><issn>0160-564X</issn><issn>1525-1594</issn><eissn>1525-1594</eissn><abstract><![CDATA[Background
Polymyxin‐B direct hemoperfusion (PMX‐DHP) is an endotoxin adsorption column‐based blood purification therapy. Since one of the most potent effects of PMX‐DHP is blood pressure elevations, it may be the most effective when it is introduced at the time when the need for vasopressors is the greatest, which, in turn, may reduce mortality.
Methods
A multicenter retrospective study was conducted at 24 ICUs in Japan. In each ICU, the 20 most recent consecutive cases of septic shock treated with PMX‐DHP were analyzed. The duration between the time of the peak vasopressive agent dose, expressed as the noradrenaline equivalent dose (NEq), and the time of PMX initiation was evaluated. The primary outcome was 28‐day mortality, and a multivariable analysis was performed to investigate factors associated with mortality.
Results
A total of 480 septic shock patients were included in the analysis. Among all patients, the 28‐day mortality group was older, more severely ill, and had a higher body mass index. The NEq peak and NEq on PMX‐DHP initiation were both higher in deceased patients. Regarding the timing of PMX‐DHP initiation from the NEq peak, −4 << 4 h had more survivors (229/304, 75.3%) than ≤−4 h (50/75, 66.7%) and ≥4 h (66/101, 65.4%) (p = 0.085). When −4 << 4 h was assigned as a reference, the timing of PMX‐DHP initiation from the NEq peak of ≤−4 h had an odds ratio of 1.96 (1.07–3.58), p = 0.029, while ≥4 h had an odds ratio of 1.64 (0.94–2.87), p = 0.082 for 28‐day mortality, in the multivariable regression analysis. A spline curve of the relationship between the probability of death and the timing of PMX‐DHP initiation from the NEq peak showed a downward convex curve with a nadir at timing = 0. The odds ratios of the timing of PMX‐DHP initiation other than −4 << 4 h were significantly higher in an older age, male sex, lower BMI, more severe illness, and higher oxygenation.
Conclusions
The induction of PMX‐DHP at the time of the peak vasopressor dose correlated with lower mortality. PMX‐DHP is one of the options available for elevating blood pressure in septic shock, and its initiation either too early or late for shock peak may not improve the outcome.
The timing of PMX‐DHP initiation from the vasopressor peak was one of the important factors to have an impact on mortality. PMX‐DHP would be one of the options available for elevating blood pressure in septic shock, and its inappropriate initiation may not improve the outcome.]]></abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>39291793</pmid><doi>10.1111/aor.14865</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-8481-0294</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0160-564X |
| ispartof | Artificial organs, 2025-02, Vol.49 (2), p.218-228 |
| issn | 0160-564X 1525-1594 1525-1594 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3106461277 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Blood pressure blood purification Body mass index Body size Catecholamine Catecholamines Endotoxins Female Hemoperfusion Hemoperfusion - methods hemo‐absorption Humans Intensive Care Units Japan - epidemiology Male Middle Aged Mortality Noradrenaline Norepinephrine Observational studies Oxygenation PMX‐DHP Polymyxin B - administration & dosage Polymyxin B - therapeutic use Pressure effects Regression analysis Retrospective Studies Sepsis Septic shock Shock, Septic - mortality Shock, Septic - therapy Spline functions Statistical analysis Time Factors Treatment Outcome Vasoconstrictor Agents - administration & dosage Vasoconstrictor Agents - therapeutic use |
| title | The polymyxin‐B direct hemoperfusion OPTimal Initiation timing with Catecholamine PMX‐OPTIC study: A multicenter retrospective observational study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T12%3A40%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20polymyxin%E2%80%90B%20direct%20hemoperfusion%20OPTimal%20Initiation%20timing%20with%20Catecholamine%20PMX%E2%80%90OPTIC%20study:%20A%20multicenter%20retrospective%20observational%20study&rft.jtitle=Artificial%20organs&rft.au=Nakamura,%20Kensuke&rft.date=2025-02&rft.volume=49&rft.issue=2&rft.spage=218&rft.epage=228&rft.pages=218-228&rft.issn=0160-564X&rft.eissn=1525-1594&rft_id=info:doi/10.1111/aor.14865&rft_dat=%3Cproquest_cross%3E3157902823%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3157902823&rft_id=info:pmid/39291793&rfr_iscdi=true |