Impact of timing of polymyxin B‐immobilized fiber column direct hemoperfusion on outcome in patients with septic shock: a single‐center observational study

Aim The effect of polymyxin B‐immobilized fiber column direct hemoperfusion (PMX‐DHP) is controversial. The present study investigates whether outcome in septic shock patients is affected by the time until PMX‐DHP initiation and the location of the infection site (intra‐ or extra‐abdominal infection (IAI/EAI)]. Methods This retrospective observational study included patients receiving PMX‐DHP for septic shock but excluded those treated after cardiac surgery or cardiac arrest. Based on the median and/or quartile time from catecholamine treatment to PMX‐DHP initiation, the patient cohort was divided into four groups and the IAI and EAI groups into two subgroups. Results Among the 49 eligible patients, overall 90‐day mortality in group 1 (PMX‐DHP within 6 h) at 8.3% was significantly lower than in groups 2 (6–9 h; 46.1%), 3 (9–29 h; 58.3%) and 4 (>29 h; 75.0%) (P = 0.021). Multivariate logistic regression analysis showed that the duration from catecholamine treatment to PMX‐DHP initiation correlated with 90‐day mortality (odds ratio 1.060; 95% confidence interval, 1.004–1.117; P = 0.028). Among the 29 IAI patients, 90‐day mortality was significantly lower in the early (within 9 h) than the late group (>9 h) (13.3% versus 64.2%; P = 0.003), but no significant intergroup difference was noted among the 20 EAI patients. Conclusion Our results suggest that early PMX‐DHP initiation (within 9 h after catecholamine treatment) reduces mortality from septic shock, especially in IAI patients. Survival study of patients with intra‐abdominal infection and extra‐abdominal infection. Kaplan‐Meier survival curves according to the infection site and the interval between catecholamine administration and PMX‐DHP initiation. (a) Intra‐abdominal infection group (n = 29): early group (within 9 h) and late group (>9 h). (b) Extra‐abdominal infection group (n = 20): early group (within 9 h) and late group (>9 h).