Early initiation of polymyxin B hemoperfusion therapy for cancer patients with refractory septic shock

PurposeIn this study, we analyzed correlations between 28-day mortality and hemodynamic changes, measured using polymyxin B-immobilized fiber column direct hemoperfusion initiation time, in patients with cancer with refractory septic shock. Materials and methodsWe retrospectively analyzed 45 patients with cancer who received polymyxin B-immobilized fiber column direct hemoperfusion due to refractory septic shock. Patients were categorized into early (<12 h between refractory septic shock and initiation of polymyxin B-immobilized fiber column direct hemoperfusion) and late (>12 h) initiation groups. Changes in vasoactive inotrope scores, sequential organ failure assessment scores, and PaO2/FiO2 ratios before and 24 h after polymyxin B-immobilized fiber column direct hemoperfusion, were compared. ResultsUnivariable analysis showed that 28-day mortality risk was associated with diabetes mellitus (odds ratio=3.081; 95% confidence interval =1.290-7.360; p=0.011), lactic acid (odds ratio=1.010; 95% confidence interval =1.005- 1.014; p<0.0001), and sequential organ failure assessment score (odds ratio=1.190; 95% confidence interval =1.044-1.357; p=0.009). Multivariable analysis showed that 28-day mortality risk was associated with diabetes mellitus (odds ratio=2.718; 95% confidence interval =1.013-7.291; p=0.047), early initiation (odds ratio=0.268; 95% confidence interval =0.094-0.765; p=0.014), and lactic acid (odds ratio=1.009; 95% confidence interval =1.004- 1.014; p<0.0001). Overall survival was slightly higher in the early than in the late initiation group (p=0.0515). Comparisons of variables before and 24 h after polymyxin B-immobilized fiber column direct hemoperfusion revealed that vasoactive inotrope scores decreased in both the early and late groups ({Delta}318 vs. {Delta}114; p=0.001 and p=0.005, respectively), whereas the PaO2/FiO2 ratio slightly increased ({Delta}127.5 vs. {Delta}95.6; p=0.350 and p=0.390, respectively) over time. ConclusionsIn patients with cancer with refractory septic shock, early initiation of polymyxin B-immobilized fiber column direct hemoperfusion reduced inotrope-vasopressor requirement and 28-day mortality.