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Analysis of the efficacy of direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) according to the prognostic factors in patients with colorectal perforation

Surgery Today volume 43, pages 1031–1038 (2013)Cite this article

Abstract

Purpose

Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) has been reported to improve the outcomes in patients with colorectal perforation. We retrospectively identified prognostic factors in patients with colorectal perforation and considered the efficacy of PMX-DHP based on these prognostic factors.

Methods

One hundred and fifty-six patients who underwent surgery for colorectal perforation in our department between November 1995 and March 2011 were enrolled in this study. The clinicopathological factors were compared between the survivor and non-survivor groups.

Results

There were 28 patients (17.9 %) who died within 28 days after surgery. According to the multivariate analysis, an Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 17 or more was a significant independent prognostic factor (P = 0.002, odds ratio = 5.39). There was a significant difference in the survival rates between the patients with APACHE II scores of 16 or less and those with scores of 17 or more who had received the PMX-DHP (+) (P < 0.0001).

Conclusion

The APACHE II score is useful as a prognostic factor in patients with colorectal perforation, and the survival rate was 50 % or lower among the patients with APACHE II scores of 17 or higher. Therefore, PMX-DHP appears to have limited efficacy in serious cases.

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Conflict of interest

Kiichi Sugimoto and co-authors have no conflicts of interest to declare.

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Affiliations

  1. Department of Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka, 410-2295, Japan

    Kiichi Sugimoto, Koichi Sato, Hiroshi Maekawa, Mutsumi Sakurada, Hajime Orita & Tomoaki Ito

  2. Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Kazuhiro Sakamoto

Authors
  1. Kiichi Sugimoto
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  2. Koichi Sato
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  3. Hiroshi Maekawa
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  4. Mutsumi Sakurada
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  5. Hajime Orita
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  6. Tomoaki Ito
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  7. Kazuhiro Sakamoto
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Correspondence to Kiichi Sugimoto.

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Sugimoto, K., Sato, K., Maekawa, H. et al. Analysis of the efficacy of direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) according to the prognostic factors in patients with colorectal perforation. Surg Today 43, 1031–1038 (2013). https://doi.org/10.1007/s00595-012-0399-y

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  • DOI: https://doi.org/10.1007/s00595-012-0399-y

Keywords

  • Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP)
  • Colorectal perforation
  • Prognostic factor
  • APACHE II score
  • Sepsis