Direct hemoperfusion with a polymyxin B column versus vasopressin for gram negative septic shock: a matched cohort study of the effect on survival.

Naoki Sawa, Yoshibumi Ubara, Keiichi Sumida, Rikako Hiramatsu, Eiko Hasegawa, Masayuki Yamanouchi, Junichi Hoshino, Tatsuya Suwabe, Naoyuki Uchida, Atsushi Wake, Shuichi Taniguchi, Kenmei Takaichi

Index: Clin. Nephrol. 79(6) , 463-70, (2013)

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Abstract

Vasopressin and direct hemoperfusion with an immobilized polymyxin B column (PMX) have emerged recently as treatments for septic shock. This study assessed the impact of these two treatments on the survival of patients with septic shock.A retrospective, matched cohort study was performed to compare patients who had septic shock and were treated with PMX or vasopressin. The primary endpoint was the 90-day mortality rate. 30 patients receiving PMX were matched to 30 treated with vasopressin.The 90-day survival rate was significantly higher in the vasopressin group than the PMX group (83% vs. 53%; p = 0.008). In the PMX group, the subgroup with gastrointestinal surgery had a significantly higher survival rate than the subgroup without surgery (76.9% vs. 52.9%; p = 0.01). Cox multivariate analysis showed that vasopressin therapy (versus PMX; HR = 0.27; p < 0.01). The estimated hazard ratio for the SOFA score was 1.44 (p < 0.01), and total pressor dosage an baseline was 1.26 (p = 0.01).We found a significant reduction of the mortality rate in septic shock patients who received vasopressin compared with PMX. In the PMX group, the subgroup with gastrointestinal surgery had a significantly higher survival rate than the subgroup without such surgery.