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pH after the first session of direct hemoperfusion with polymyxin B-immobilized fibers predicts mortality in patients with sepsis and septic shock

Clinical and Experimental Nephrology volume 22, pages 1167–1173 (2018)Cite this article

Abstract

Background

The definition of sepsis was updated to sepsis-3 in February 2016. Currently, direct hemoperfusion therapy using the polymyxin B-immobilized fiber cartridge (PMX-DHP) is widely performed to treat sepsis and septic shock. However, the prognostic factors of PMX-DHPs in patients with sepsis using the new definition are unclear. We retrospectively assessed prognostic factors in patients who had received PMX-DHP therapy for sepsis and septic shock.

Methods

We included 71 patients with severe infection who underwent PMX-DHP treatment from January 2006 to August 2015 in this study. Participants were re-evaluated according to the criteria of sepsis-3. The patients were divided into two groups based on having survived (n = 59) or not survived (n = 12) for 28 days after PMX-DHP treatment. Clinical data before and after PMX-DHP treatment were compared between the two groups.

Results

Non-survivors showed a lower Glasgow Coma Scale (GCS) score before PMX-DHP treatment compared with 28-day survivors [12 (6–14) vs 14 (12–15), P < 0.01]. Furthermore, pH after the first PMX-DHP session was significantly lower in non-survivors than in survivors (7.28 ± 0.23 vs 7.39 ± 0.06, P = 0.03). Multivariate logistic regression analysis showed that only lower pH after the first PMX-DHP session was a predictor of 28-day mortality independent of age, sex, GCS score, and mean arterial pressure (odds ratio per pH of 0.01, 0.93; 95% confidence interval, 0.83–0.99; P = 0.02).

Conclusion

The pH after the first PMX-DHP session is an independent risk factor for mortality in patients receiving PMX-DHP for sepsis and septic shock.

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Affiliations

  1. Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Aiko Okubo, Ayumu Nakashima, Shigehiro Doi, Toshinori Ueno, Kensuke Sasaki & Takao Masaki

  2. Department of Stem Cell Biology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan

    Ayumu Nakashima

  3. Department of Nephrology, Onomichi General Hospital, Hiroshima, Japan

    Takashi Esaki

Authors
  1. Aiko Okubo
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  2. Ayumu Nakashima
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  3. Shigehiro Doi
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  4. Toshinori Ueno
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  5. Kensuke Sasaki
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  6. Takashi Esaki
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  7. Takao Masaki
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Corresponding authors

Correspondence to Ayumu Nakashima or Takao Masaki.

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Conflict of interest

All of the authors have declared that no conflict of interest exist.

Ethical approval

This study was performed in accordance with the guidelines contained within the Declaration of Helsinki and the protocol was licensed by the hospital ethics committee of Hiroshima University Hospital (approval number: E-726, registered on March 29, 2017).

Informed consent

Written informed consent was not required because of the non-intervention and retrospective design.

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Okubo, A., Nakashima, A., Doi, S. et al. pH after the first session of direct hemoperfusion with polymyxin B-immobilized fibers predicts mortality in patients with sepsis and septic shock. Clin Exp Nephrol 22, 1167–1173 (2018). https://doi.org/10.1007/s10157-018-1548-4

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  • DOI: https://doi.org/10.1007/s10157-018-1548-4

Keywords

  • Polymyxin B hemoperfusion
  • Sepsis
  • Sepsis-3
  • Acidosis
  • Hemodynamics
  • Organ dysfunction