Exacerbation of prothrombin time-international normalized ratio before second polymyxin B cartridge hemoperfusion predicts poor outcome of patients with severe sepsis and/or septic shock

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• 作者：Mitsuru Ishizuka ; MD ; ^{mm-ishizuka@umin.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Azusa Terasaki ; MD ; Keiichi Kubota ; MD
• 关键词：Disseminated intravascular coagulation ; Polymyxin B cartridge hemoperfusion ; Prothrombin time-international normalized ratio ; Severe sepsis and/or septic shock ; 28-day mortality
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：200
• 期：1
• 页码：308-314
• 全文大小：334 K

文摘

Although polymyxin B cartridge hemoperfusion (PMX) has an important place in the treatment of patients with severe sepsis and/or septic shock (SS), there are few rigid indications for performing PMX a second time.The objective of the study was to investigate the clinicolaboratory characteristics (CCs) showing the most significant change from the first to the second PMX and associated with 28-d mortality in patients with SS.

Methods

Between April 2006 and March 2008, 78 patients with SS who had received two sessions of PMX in a prospectively collected multicenter collaboration study were enrolled. Univariate and multivariate analyses using the differences in the values of individual CCs (Δ-CCs) were performed to assess the CCs showing the most significant change in value associated with 28-d mortality. The Δ-CC was defined as: Δ_2nd-1st-CC = value of the CC just before the second PMX − value of the CC just before the first PMX.

Results

Among 28 Δ_2nd-1st-CCs, 10 Δ_2nd-1st-CCs were selected by using receiver operating characteristic (ROC) curve analyses. The results of multivariate analysis using adequate 8 Δ_2nd-1st-CCs that had been selected by univariate analyses revealed that only Δ_2nd-1st-prothrombin time–international normalized ratio (PT-INR) (≤0.16/>0.16; hazard ratio = 6.562; 95% CI = 1.525–28.23; P = 0.012) was associated with 28-d mortality. Survival curve analysis demonstrated a significant difference in 28-d mortality between patients with a lower (≤0.16) and a higher (>0.16) Δ_2nd-1st-PT-INR (P < 0.001).

Conclusions

Patients with exacerbation of PT-INR (>0.16) after initial PMX are unlikely to benefit clinically from a second PMX for treatment of SS.