Endotoxin activity trend and multi-organ dysfunction in critically ill patients with septic shock, who received Polymyxin-B hemadsorption: A multicenter, prospective, observational study

Abstract

Background: The baseline endotoxin activity (EA_T0) may predict the outcome of critically ill septic patients who receive Polymyxin-B hemadsorption (PMX-HA), however, the clinical implications of specific EA trends remain unknown.

Methods: Subgroup analysis of the prospective, multicenter, observational study EUPHAS2. We included 50 critically ill patients with septic shock and EA_T0 ≥ 0.6, who received PMX-HA. The primary outcome of the study was the EA and SOFA score progression from T₀ to 120 h afterwards (T₁₂₀). Secondary outcomes included the EA and SOFA score progression in whom had EA at 48 h (EA_T48) < 0.6 (EA responders, EA-R) versus who had not (EA non-responders, EA-NR).

Results: Septic shock was mainly caused by 27 abdominal (54%) and 17 pulmonary (34%) infections, predominantly due to Gram negative bacteria (39 patients, 78%). The SAPS II score was 67.5 [52.8-82.3] and predicted a mortality rate of 75%. Between T₀ and T₁₂₀, the EA decreased (p < 0.001), while the SOFA score and the Inotropic Score (IS) improved (p < 0.001). In comparison with EA-NR (18 patients, 47%), the EA-R group (23 patients, 53%) showed faster IS improvement and lower requirement of continuous renal replacement therapy (CRRT) during the ICU stay. Overall hospital mortality occurred in 18 patients (36%).

Conclusions: In critically ill patients with septic shock and EA_T0 ≥ 0.6 who received PMX-HA, EA decreased and SOFA score improved over 120 h. In whom high EA resolved within 48 h, IS improvement was faster and CRRT requirement was lower compared with patients with EA_T48 ≥ 0.6.

Keywords: ICU; critical care; endotoxin; polymyxin‐b hemadsorption; sepsis; septic shock.