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...
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| Veröffentlicht in: | Acute medicine & surgery 2020-01, Vol.7 (1), p.e446-n/a |
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| creator | Tanaka, Tomoki Tabata, Takahisa Fujino, Kazunori Tsujita, Yasuyuki Eguchi, Yutaka |
| description | 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). |
| doi_str_mv | 10.1002/ams2.446 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6971457</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2347510443</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3926-7f85056cde6bcec1f95714bd518e25ae920ae159957f99f9afb0d86173f7c1f83</originalsourceid><addsrcrecordid>eNp1kdFq1zAUh4so25iDPYEEvPGmW9ImbeOFMIe6wcQL53VI05P9M5OmJulmvfIRfAPfzScxZXNOYRBISL7znRN-RbFP8AHBuDqULlYHlDaPip0Ks6rsOtI-vnfeLvZivMQYE4LrpiFbxXZNeNe1Dd4pfp66SaqEvEbJODNerKfJ28UtX82IXv_6_sM453tjzTcYkDY9BKS8nd2IBhMgl27A-QmCnqPxI1rXnJR3gHL9JJOBMUV0bdIGRZiSUShuvPr8EkkUcz8LuYXKTPb6PkK4yiV-lBbFNA_L0-KJljbC3u2-W3x6--b8-KQ8-_Du9PjorFQ1r5qy1R3DrFEDNL0CRTRnLaH9wEgHFZPAKyyBMJ6vNeeaS93joWtIW-s20129W7y68U5z72BYBwrSiikYJ8MivDTi35fRbMSFvxINz41YmwUvbgXBf5khJuFMVGCtHMHPUVQ1bRnBlNYZff4feunnkL-cKdrSmvKasr9CFXyMAfTdMASLNXixBi9y8Bl9dn_4O_BPzBkob4BrY2F5UCSO3n-sVuFvx1-9iA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2474349345</pqid></control><display><type>article</type><title>Impact of timing of polymyxin B‐immobilized fiber column direct hemoperfusion on outcome in patients with septic shock: a single‐center observational study</title><source>Wiley Online Library Open Access</source><source>DOAJ Directory of Open Access Journals</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><creator>Tanaka, Tomoki ; Tabata, Takahisa ; Fujino, Kazunori ; Tsujita, Yasuyuki ; Eguchi, Yutaka</creator><creatorcontrib>Tanaka, Tomoki ; Tabata, Takahisa ; Fujino, Kazunori ; Tsujita, Yasuyuki ; Eguchi, Yutaka</creatorcontrib><description>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).</description><identifier>ISSN: 2052-8817</identifier><identifier>EISSN: 2052-8817</identifier><identifier>DOI: 10.1002/ams2.446</identifier><identifier>PMID: 31988760</identifier><language>eng</language><publisher>United States: John Wiley & Sons, Inc</publisher><subject>Abdomen ; Age ; Catecholamines ; Endotoxin tolerance ; extra‐abdominal infection ; Hospitals ; Infections ; intra‐abdominal infection ; Kidneys ; Mortality ; Observational studies ; Original ; Patients ; PMX‐DHP ; Polymethyl methacrylate ; Sepsis ; SOFA score ; Surgery</subject><ispartof>Acute medicine & surgery, 2020-01, Vol.7 (1), p.e446-n/a</ispartof><rights>2019 The Authors. published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine</rights><rights>2019 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.</rights><rights>2020. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3926-7f85056cde6bcec1f95714bd518e25ae920ae159957f99f9afb0d86173f7c1f83</citedby><cites>FETCH-LOGICAL-c3926-7f85056cde6bcec1f95714bd518e25ae920ae159957f99f9afb0d86173f7c1f83</cites><orcidid>0000-0002-5990-0498</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971457/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971457/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,1411,11541,27901,27902,45550,45551,46027,46451,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31988760$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tanaka, Tomoki</creatorcontrib><creatorcontrib>Tabata, Takahisa</creatorcontrib><creatorcontrib>Fujino, Kazunori</creatorcontrib><creatorcontrib>Tsujita, Yasuyuki</creatorcontrib><creatorcontrib>Eguchi, Yutaka</creatorcontrib><title>Impact of timing of polymyxin B‐immobilized fiber column direct hemoperfusion on outcome in patients with septic shock: a single‐center observational study</title><title>Acute medicine & surgery</title><addtitle>Acute Med Surg</addtitle><description>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).</description><subject>Abdomen</subject><subject>Age</subject><subject>Catecholamines</subject><subject>Endotoxin tolerance</subject><subject>extra‐abdominal infection</subject><subject>Hospitals</subject><subject>Infections</subject><subject>intra‐abdominal infection</subject><subject>Kidneys</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Original</subject><subject>Patients</subject><subject>PMX‐DHP</subject><subject>Polymethyl methacrylate</subject><subject>Sepsis</subject><subject>SOFA score</subject><subject>Surgery</subject><issn>2052-8817</issn><issn>2052-8817</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kdFq1zAUh4so25iDPYEEvPGmW9ImbeOFMIe6wcQL53VI05P9M5OmJulmvfIRfAPfzScxZXNOYRBISL7znRN-RbFP8AHBuDqULlYHlDaPip0Ks6rsOtI-vnfeLvZivMQYE4LrpiFbxXZNeNe1Dd4pfp66SaqEvEbJODNerKfJ28UtX82IXv_6_sM453tjzTcYkDY9BKS8nd2IBhMgl27A-QmCnqPxI1rXnJR3gHL9JJOBMUV0bdIGRZiSUShuvPr8EkkUcz8LuYXKTPb6PkK4yiV-lBbFNA_L0-KJljbC3u2-W3x6--b8-KQ8-_Du9PjorFQ1r5qy1R3DrFEDNL0CRTRnLaH9wEgHFZPAKyyBMJ6vNeeaS93joWtIW-s20129W7y68U5z72BYBwrSiikYJ8MivDTi35fRbMSFvxINz41YmwUvbgXBf5khJuFMVGCtHMHPUVQ1bRnBlNYZff4feunnkL-cKdrSmvKasr9CFXyMAfTdMASLNXixBi9y8Bl9dn_4O_BPzBkob4BrY2F5UCSO3n-sVuFvx1-9iA</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Tanaka, Tomoki</creator><creator>Tabata, Takahisa</creator><creator>Fujino, Kazunori</creator><creator>Tsujita, Yasuyuki</creator><creator>Eguchi, Yutaka</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5990-0498</orcidid></search><sort><creationdate>202001</creationdate><title>Impact of timing of polymyxin B‐immobilized fiber column direct hemoperfusion on outcome in patients with septic shock: a single‐center observational study</title><author>Tanaka, Tomoki ; Tabata, Takahisa ; Fujino, Kazunori ; Tsujita, Yasuyuki ; Eguchi, Yutaka</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3926-7f85056cde6bcec1f95714bd518e25ae920ae159957f99f9afb0d86173f7c1f83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdomen</topic><topic>Age</topic><topic>Catecholamines</topic><topic>Endotoxin tolerance</topic><topic>extra‐abdominal infection</topic><topic>Hospitals</topic><topic>Infections</topic><topic>intra‐abdominal infection</topic><topic>Kidneys</topic><topic>Mortality</topic><topic>Observational studies</topic><topic>Original</topic><topic>Patients</topic><topic>PMX‐DHP</topic><topic>Polymethyl methacrylate</topic><topic>Sepsis</topic><topic>SOFA score</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tanaka, Tomoki</creatorcontrib><creatorcontrib>Tabata, Takahisa</creatorcontrib><creatorcontrib>Fujino, Kazunori</creatorcontrib><creatorcontrib>Tsujita, Yasuyuki</creatorcontrib><creatorcontrib>Eguchi, Yutaka</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Acute medicine & surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tanaka, Tomoki</au><au>Tabata, Takahisa</au><au>Fujino, Kazunori</au><au>Tsujita, Yasuyuki</au><au>Eguchi, Yutaka</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of timing of polymyxin B‐immobilized fiber column direct hemoperfusion on outcome in patients with septic shock: a single‐center observational study</atitle><jtitle>Acute medicine & surgery</jtitle><addtitle>Acute Med Surg</addtitle><date>2020-01</date><risdate>2020</risdate><volume>7</volume><issue>1</issue><spage>e446</spage><epage>n/a</epage><pages>e446-n/a</pages><issn>2052-8817</issn><eissn>2052-8817</eissn><abstract>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).</abstract><cop>United States</cop><pub>John Wiley & Sons, Inc</pub><pmid>31988760</pmid><doi>10.1002/ams2.446</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-5990-0498</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library Open Access; DOAJ Directory of Open Access Journals; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Abdomen Age Catecholamines Endotoxin tolerance extra‐abdominal infection Hospitals Infections intra‐abdominal infection Kidneys Mortality Observational studies Original Patients PMX‐DHP Polymethyl methacrylate Sepsis SOFA score Surgery |
| title | Impact of timing of polymyxin B‐immobilized fiber column direct hemoperfusion on outcome in patients with septic shock: a single‐center observational study |
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