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Effects of direct hemoperfusion with polymyxin B-immobilized fiber on rapidly progressive interstitial lung diseases
Toshinori Takada1, Katsuaki Asakawa, Takuro Sakagami
1Division of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Japan.
Objective:
Direct hemoperfusion with polymyxin B-immobilized fiber columns (PMX-DHP) has been used for the treatment of septic shock. It was recently suggested that PMX-DHP may also be effective in acute exacerbations of idiopathic pulmonary fibrosis (IPF). However, all previous reports are case series without controls. The aim of the study was to determine the effects of PMX-DHP on the prognosis of the patients with rapidly progressive interstitial lung diseases (ILDs) in a case-control setting.
Methods:
We herein retrospectively examined the clinical records of consecutive patients with acute exacerbation of IPF or rapidly progressive ILDs treated in our institute. We excluded those who had been treated with steroid pulse therapy for lung diseases, including those who had been taking more than 15 mg of oral prednisolone daily, or had undergone an operation within one month before the onset of acute respiratory failure. We compared the results of the laboratory tests and survivals between patients treated with and without PMX-DHP.
Results:
Twenty-six patients were enrolled in the study. Among them, 13 patients were treated with PMX-DHP in addition to immunosuppressive therapy, including steroid pulse therapy. The mean survival time of patients treated with PMX-DHP tended to be longer than patients not treated with PXM-DHP (p=0.067). Six patients who underwent PMX-DHP on the first day of steroid pulse therapy had significantly longer survival times than those who were treated with standard medication alone (p<0.01).
Conclusion:
These results suggest that PMX-DHP performed on the first day of steroid pulse therapy may improve the prognosis of patients with rapidly progressive ILDs.
Insights
Polymyxin B-immobilized fiber column (PMX-DHP) treatment may improve survival in patients with rapidly progressive interstitial lung diseases (ILDs). Early PMX-DHP initiation alongside steroid pulse therapy showed significantly better outcomes in this patient group.
Area of Science:
- Pulmonology
- Critical Care Medicine
- Nephrology
Background:
- Direct hemoperfusion with polymyxin B-immobilized fiber columns (PMX-DHP) is established for septic shock.
- Emerging evidence suggests PMX-DHP efficacy in idiopathic pulmonary fibrosis (IPF) exacerbations.
- Previous studies were limited to case series without control groups.
Purpose of the Study:
- To evaluate the impact of PMX-DHP on prognosis in patients with rapidly progressive interstitial lung diseases (ILDs).
- To conduct a case-control study assessing PMX-DHP effectiveness in ILD exacerbations.
Main Methods:
- Retrospective analysis of clinical records of patients with acute exacerbation of IPF or rapidly progressive ILDs.
- Exclusion criteria included recent high-dose steroid therapy or surgery.
- Comparison of laboratory tests and survival rates between PMX-DHP treated and untreated groups.
Main Results:
- 13 of 26 patients received PMX-DHP in addition to immunosuppressive therapy.
- PMX-DHP treated patients showed a trend towards longer mean survival time (p=0.067).
- Patients receiving PMX-DHP on day one of steroid pulse therapy had significantly improved survival (p<0.01).
Conclusions:
- PMX-DHP may enhance prognosis for patients with rapidly progressive ILDs.
- Early administration of PMX-DHP on the first day of steroid pulse therapy appears most beneficial.
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