Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2019; 11(12): 422-432
Published online Dec 27, 2019. doi: 10.4240/wjgs.v11.i12.422
Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock
Jin Joo Kim, Young Jun Park, Ki Yoon Moon, Jin Hyeong Park, Yong Ki Jeong, Eun Young Kim
Jin Joo Kim, Eun Young Kim, Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea
Young Jun Park, Ki Yoon Moon, Jin Hyeong Park, Yong Ki Jeong, Department of Surgery, Seoul St. Mary’s Hospital, Seoul 137-701, South Korea
Author contributions: All authors helped to perform the research; Kim JJ is the lead investigator, collected the data, designed the study, performed literature search and wrote the manuscript; Park YJ performed literature search and the statistical analysis; Moon KY, Park JH and Jeong YK collected the data and revised manuscript; Kim EY revised the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Seoul St. Mary’s hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Eun Young Kim, MD, PhD, Assistant Professor, Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul 137-701, South Korea. freesshs@naver.com
Telephone: +82-2-22582876 Fax: +82-2-5952822
Received: July 19, 2019
Peer-review started: July 22, 2019
First decision: September 21, 2019
Revised: October 8, 2019
Accepted: November 20, 2019
Article in press: November 20, 2019
Published online: December 27, 2019
Processing time: 143 Days and 19.5 Hours
Abstract
BACKGROUND

Polymyxin B hemoperfusion (PMX-HP) has been used as a treatment for intra-abdominal septic shock by absorbing and removing endotoxins of gram-negative bacilli.

AIM

To investigate the clinical efficacy of PMX-HP in patients with gram-negative septic shock who underwent abdominal surgery.

METHODS

From January 2012 to December 2018, patients who had septic shock secondary to peritonitis were enrolled. They were classified into PMX-HP treated and control groups based on postopreative intervention using PMX-HP. The clinical outcomes were compared using 1:1 propensity score matching methods to balance the overall distribution between the two groups.

RESULTS

After propensity score matching, 40 patients were analyzed (20 patients in the PMX group and 20 patients in the control group). The scores of total Sequential Organ Failure Assessment (SOFA) score, renal SOFA and coagulation SOFA were significantly improved in the PMX group but not in the control group. (from 11.2 ± 5.8 to 4.7 ± 3.5 in PMX group vs 10.0 ± 4.0 to 8.7 ± 7.3 in control group, P = 0.047 from 2.6 ± 1.0 to 0.7 ± 1.0 in PMX group vs 2.6 ± 1.5 to 2.8 ± 1.6 in control group, P = 0.000, from 1.6 ± 1.5 to 1.3 ± 1.3 in PMX group vs 1.2 ± 1.2 to 2.8 ± 1.8 in control group, P = 0.014, respectively). Further, the length of intensive care unit (ICU) stay was significantly shorter in PMX group. However, no statistically significant difference was found in ICU mortality (50% in PMX group vs 50% in control group).

CONCLUSION

PMX-HP is a feasible adjunct treatment for peritonitis in ICU patients with peritonitis for improved organ impairment and to stabilize hemodynamics. It would be helpful to enhance clinical outcomes especially in patients with complete elimination of the source of gram-negative bacilli infection by surgical procedure accompanied with conventional treatment of sepsis.

Keywords: Intraabdominal septic shock; Panperitonitis; Polymyxin B hemoperfusion; Sepsis; Toraymyxin

Core tip: Polymyxin B hemoperfusion (PMX-HP) has been proposed as a treatment for intra-abdominal septic shock by eliminating endotoxins of gram-negative bacilli. The aim of this study was to investigate the clinical efficacy of PMX-HP using propensity score matching in patients with gram-negative septic shock who underwent abdominal surgery. Forty patients were analyzed (20 patients in the PMX group and 20 patients in the control group) and there were significant improvement for total Sequential Organ Failure Assessment (SOFA) score, renal SOFA and coagulation SOFA were significantly improved in the PMX group. Furthermore, the length of intensive care unit stay was significantly shorter in PMX group.