Hemodynamic response by polymyxin B hemoperfusion and its clinical outcomes in patients with refractory septic shock: A post-hoc sub-analysis of prospective cohort study

Polymyxin B hemoperfusion (PMX-HP) reportedly improves hemodynamic status in some but not all patients with septic shock. We examined the association between hemodynamic response and clinical outcomes and explored factors that may identify patients with hemodynamic response. BEAT-SHOCK registry is a prospective cohort study of 309 consecutive adult patients with septic shock requiring high-dose norepinephrine. This predefined sub-analysis included 82 patients treated with PMX-HP. We defined hemodynamic response as a ≥ 20% improvement within 6 h of starting PMX-HP in the modified vasopressor dependency index, representing vasopressor dosage divided by mean arterial pressure. The median modified vasopressor dependency index at the start of PMX-HP was 0.56 mmHg-1, and 0.34 mmHg-1 6 h after starting PMX-HP (median relative change -32%). Hemodynamic response was obtained in 53 patients (65%; responder group). The 28-day mortality rate was 8% (4/53) in the responder group and 31% (9/29) in the non-responder group (P = 0.0042). Three potential factors were: lower SOFA score (≤10, adjusted odds ratio [aOR] 3.36), abdominal or urinary tract infection (aOR 2.49), and higher modified vasopressor dependency index at the start of PMX-HP (≥0.5 mmHg-1, aOR 2.14). Patients with two or three factors were likely to respond to PMX-HP. Among patients with refractory septic shock, 65% had hemodynamic response after PMX-HP, and it was associated with better clinical outcomes, as shown by the higher survival rate. The number of the following factors was associated with the likelihood of hemodynamic response: less organ dysfunction, more vasopressors, and abdominal/urinary tract infection. UMIN Clinical Trial Registry on 1 November 2019 (registration no. UMIN000038302).