Efficacy of use of Polymyxin B Hemoperfusion in patients with sepsis: A Korean multicenter cohort study

Abstract

PURPOSE Although Polymyxin B hemoperfusion improved the survival of patients with sepsis in a meta-analysis, its effectiveness remains controversial due to the high risk of bias. We aimed to determine whether PMX-HP is effective in sepsis patients.

MATERIALS AND METHODS This retrospective study evaluated the efficacy of PMX-HP compared with continuous renal replacement therapy (CRRT), in delaying progression to multiple organ failure (MOF) determined using the delta Sequential Organ Failure Assessment (SOFA) scores of 194 critically ill sepsis patients from 15 different hospitals in South Korea. The secondary outcomes included in-hospital mortality rate, length of ICU stay, change in clinical frailty scale, ventilator-free days within 28 days, and length of hospital stay.

RESULTS Among 194 eligible patients (mean age, 68.9 years; 90[46.9%] women, mean SOFA score 8.61), 41 received Polymyxin B hemoperfusion treatment (PMX-HP), while 153 patients received CRRT. Polymyxin B hemoperfusion did not show advantage of slowing progression in multiple organ failure progression over CRRT (change in SOFA between day0 and day7, 1.83 vs 1.32; p=0.012; change in SOFA between day0 and day14, 1.83 vs 2.17; p=0.368). The 7-day (hazard ratio [HR], 0.182; 95% confidence interval [CI], 0.057 to 0.581; p=0.004), 14-day ([HR], 0.39; 95% [CI], 0.129 to 0.690; p=0.005), 28-day mortality rate ([HR], 0.39; 95% [CI], 0.19 to 0.78; p=0.008) were not significantly different between the two groups. The number of ventilator-free day within 28 days (absolute difference [AD], 0.8 days; standard deviation (SD), 1.36; 95% CI, −3.49 to 1.88; p=0.557), length of ICU stay (AD, 2.15 days; SD, 1.98; 95% CI, −1.75 to 6.06; p=0.278), clinical frailty scale change (p=0.051), and change in the use of vasopressor (p=0.158) were not significantly different between the two groups. Meanwhile, a significant difference was observed in platelet count change (p=0.019) and length of hospital stay (p=0.003) between the two groups.

CONCLUSIONS In sepsis patients, PMX-HP treatment did not significantly lead to delayed progression to MOF compared with CRRT