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Direct hemoperfusion using polymyxin-B immobilized fiber for severe septic patients with hematological disorders: a

Minako Mori1, Takashi Onaka1, Akihito Yonezawa1

  • 1Department of Hematology, Kokura Memorial Hospital, Kitakyushu, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|February 4, 2014
PubMed

Insights

Endotoxin absorption therapy (direct hemoperfusion with polymyxin B-immobilized fiber: PMX-DHP) may be less effective for severe septic patients with hematological disorders. Patients with serious organ dysfunction (SOFA score ≥11) showed poor outcomes with PMX-DHP.

Area of Science:

  • Critical Care Medicine
  • Hematology
  • Infectious Diseases

Background:

  • The efficacy of endotoxin absorption therapy (direct hemoperfusion with polymyxin B-immobilized fiber: PMX-DHP) for severe septic patients remains debated.
  • Limited data exist on PMX-DHP's clinical experience and effectiveness in septic patients with hematological disorders.

Purpose of the Study:

  • To evaluate the clinical experience and efficacy of PMX-DHP in patients with hematological diseases and gram-negative septic shock.
  • To identify factors predicting therapeutic efficacy of PMX-DHP in this patient population.

Main Methods:

  • Retrospective analysis of 16 patients with hematological diseases who underwent PMX-DHP for gram-negative septic shock (February 2006–March 2012).
  • Analysis of clinical characteristics, including Sequential Organ Failure Assessment (SOFA) scores, before PMX-DHP therapy.
  • Comparison of clinical data between patients who recovered (favorable group) and those who died (unfavorable group).

Main Results:

  • Six patients (37.5%) recovered from shock (favorable group), while ten (62.5%) died (unfavorable group).
  • Patients in the favorable group had a pre-therapy SOFA score less than 11.
  • A SOFA score less than 11 demonstrated 100% sensitivity and 80% specificity for predicting therapeutic efficacy of PMX-DHP.

Conclusions:

  • Septic patients with hematological diseases and severe organ dysfunction (SOFA score ≥11) may not be suitable candidates for PMX-DHP therapy.
  • Early assessment of organ dysfunction using SOFA scores is crucial for determining PMX-DHP candidacy in this population.
Keywords:
EndotoxinHematological diseasePolymyxin B hemoperfusionSeptic shockSequential organ failure assessment score

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