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Effectiveness of polymyxin B hemoperfusion for sepsis depends on the baseline SOFA score: a nationwide observational
Kenji Fujimori1, Kunio Tarasawa2, Kiyohide Fushimi3
1Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan. fujimori@med.tohoku.ac.jp.
Background:
Polymyxin B hemoperfusion (PMX) aims to treat septic shock by removing endotoxin from the patient's blood. However, the relationship between the severity of the patient's organ damage and the survival benefit of PMX treatment is not clear.
Methods:
We analyzed the efficacy of PMX on adult sepsis patients using the propensity score matching method and the Japanese Diagnosis Procedure Combination (DPC) national inpatient database from April 2018 to March 2020. We stratified the patients into five categories based on their baseline Sequential Organ Failure Assessment (SOFA) score and compared the mortality between PMX-treated and non-treated groups in each category. We also compared continuous hemodiafiltration (CHDF)-, ventilator- and noradrenaline-free days between the groups.
Results:
Of 44,177 patients included in the study, 2191 received PMX. After 1:1 propensity score matching, we created matched cohorts of 2033 pairs. PMX significantly improved the survival of the patients in the SOFA score categories of 7-9 and 10-12. On the other hand, there was no significant difference in the survival rate in SOFA score categories of 0-6, 13-15, and 16-24. In analyzing organ support-free days, PMX was also beneficial in the 7-9 and 10-12 SOFA categories compared to other categories.
Conclusion:
Analysis of a large-scale Japanese inpatient database found a significant association between PMX efficacy and baseline SOFA score. This result indicates higher efficacy in patients with medium SOFA scores in the range of 7-12. The result provides a promising hypothesis for selecting appropriate patients for PMX and should be validated in future RCTs.
Insights
Polymyxin B hemoperfusion (PMX) improved survival in septic shock patients with moderate organ dysfunction (SOFA scores 7-12). This endotoxin removal therapy showed no significant benefit for patients with mild or severe organ damage.
Area of Science:
- Critical Care Medicine
- Nephrology
- Infectious Diseases
Background:
- Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection.
- Polymyxin B hemoperfusion (PMX) is used to remove endotoxin in septic shock.
- The impact of organ damage severity on PMX efficacy remains unclear.
Purpose of the Study:
- To investigate the relationship between baseline organ damage severity and the survival benefit of PMX in adult sepsis patients.
- To identify patient subgroups that may benefit most from PMX treatment.
Main Methods:
- Retrospective analysis of a large Japanese inpatient database (April 2018 - March 2020).
- Propensity score matching (1:1) applied to compare PMX-treated and non-treated groups.
- Patients stratified into five Sequential Organ Failure Assessment (SOFA) score categories.
Main Results:
- PMX significantly improved survival in patients with SOFA scores of 7-9 and 10-12.
- No significant survival benefit observed in SOFA score categories 0-6, 13-15, and 16-24.
- PMX also increased organ support-free days in the 7-9 and 10-12 SOFA categories.
Conclusions:
- PMX efficacy in septic shock is associated with baseline organ damage severity.
- PMX demonstrates higher efficacy in patients with moderate organ dysfunction (SOFA scores 7-12).
- Findings suggest a potential role for SOFA score in guiding PMX patient selection, requiring validation in randomized controlled trials.
