Effectiveness of polymyxin B hemoperfusion for sepsis depends on the baseline SOFA score: a nationwide observational study

Abstract

\n Background: Polymyxin B hemoperfusion (PMX) aims to prevent septic shock by removing endotoxin from the patient’s blood. However, the relationship between the severity of the patient s organ damage and the efficacy of PMX treatment is not clear.Methods: We analyzed the efficacy of PMX on adult sepsis patients using the propensity score matching method and the Japanese Diagnosis Procedure Combination (DPC) national inpatient database from April 2018 to March 2020. We stratified the patients into five categories based on their baseline sequential organ failure assessment (SOFA) score and compared the mortality between PMX-treated and non-treated groups in each category. We also compared continuous hemodiafiltration (CHDF)-. ventilator- and noradrenaline-free days between the groups.Results: Of 44,177 patients included in the study, 2,191 received PMX. After 1:1 propensity score matching, we created matched cohorts of 2,033 pairs. PMX significantly improved the survival of the patients in the SOFA score categories of 7–9 and 10–12. On the other hand, there was no significant difference in the survival rate in SOFA score categories of 0–6, 13–15, and 16–24. In the analysis of organ support-free days, PMX was also effective in the SOFA categories of 7–9 and 10–12, compared to other categories.Conclusion: Analysis of large-scale Japanese inpatient database found that PMX is effective for patients with moderate severity of organ dysfunction with the SOFA score range of 7 to 12. The study provides essential information for the selection of suitable patients for PMX treatment.