Time to administer polymyxin B hemoperfusion and hemodynamics in patients with septic shock requiring high-dose norepinephrine: a predetermined analysis of a prospective cohort study

• Published in: Critical care (London, England) Vol. 29; no. 1; p. 187
• Main Authors: Miyamoto, Kyohei, Kawazoe, Yu, Miyagawa, Noriko, Yamamura, Hitoshi, Ohta, Yoshinori, Kimura, Takuya, Toyoda, Yukitoshi, Kyo, Michihito, Sato, Tetsuya, Kinjo, Masashi, Takahashi, Masaki, Maruyama, Junichi, Matsuura, Hiroshi, Fukushima, Kazunori, Murata, Satoru, Okazaki, Tomoya, Suzuki, Tsuyoshi, Sakurai, Toshihiro, Takahashi, Gaku, Hanajima, Tasuku, Morimoto, Takeshi
• Format: Journal Article
• Language: English
• Published: London BioMed Central 09.05.2025; BioMed Central Ltd
• Subjects: Aged; Aged, 80 and over; Analysis; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Biological research; Care and treatment; Chronic illnesses; Clinical trials; Cohort Studies; Critical Care Medicine; Diagnosis; Dopamine; Dosage and administration; Drug dosages; Emergency Medicine; Ethics; Female; Heart failure; Hemodynamic monitoring; Hemodynamics; Hemodynamics - drug effects; Hemodynamics - physiology; Hemoperfusion - methods; Hemoperfusion - standards; Human subjects; Humans; Infections; Intensive; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Male; Medicine; Medicine & Public Health; Methods; Middle Aged; Mortality; Noradrenaline; Norepinephrine - administration & dosage; Norepinephrine - pharmacology; Norepinephrine - therapeutic use; Observational studies; Polymyxin B; Polymyxin B - administration & dosage; Polymyxin B - pharmacology; Polymyxin B - therapeutic use; Prospective Studies; Registries - statistics & numerical data; Risk factors; Sensitivity analysis; Sepsis; Septic shock; Shock, Septic - drug therapy; Shock, Septic - physiopathology; Shock, Septic - therapy; Time Factors; Urogenital system; Variables; Vasoconstrictor Agents - administration & dosage; Vasoconstrictor Agents - therapeutic use; Japan; Polymyxin B hemoperfusion; Blood purification; Septic shock
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1466-609X; 1366-609X
• DOI: 10.1186/s13054-025-05422-7

Background Delayed administration of polymyxin B hemoperfusion (PMX-HP) for septic shock could diminish its efficacy in real-world clinical settings. Methods BEAT-SHOCK (BEst Available Treatment for septic SHOCK) registry is a prospective registry consisting of 309 adult patients with septic shock requiring high-dose norepinephrine (≥ 0.2 μg/kg/min). This predetermined analysis included 82 patients treated with PMX-HP. They were grouped according to the median time from intensive care unit (ICU) admission to administration of PMX-HP: the early administration group (n = 40) and the late administration group (n = 42). The primary outcome was short-term hemodynamic status, including mean arterial pressure and vasoactive-inotropic score (VIS; calculated from doses of dopamine, dobutamine, norepinephrine, epinephrine, vasopressin, milrinone, and levosimendan) within 48 h after ICU admission. Results The median time from ICU admission to administration of PMX-HP was 265 min (interquartile range [IQR]: 113–480). The median ages were 70 (IQR: 59–81) and 72 (IQR: 64–80) years ( P  = 0.77), and 21/40 (53%) and 25/42 (60%) patients were male ( P  = 0.52) in the early and late administration groups, respectively. The dose of norepinephrine at ICU admission was 0.33 (IQR: 0.24–0.47) and 0.30 (IQR: 0.22–0.34) μg/kg/min in the early and late administration groups, respectively ( P  = 0.17). Within 48 h after ICU admission, mean arterial pressure was significantly higher at 6 h and 8 h, and VIS was significantly lower at 8 h and thereafter in the early administration group. Within a 28-day period, there were 23 (IQR: 21–25) and 21 (IQR: 0–24) vasopressor/inotrope-free days ( P  = 0.027), and 18 (IQR: 1–23) and 14 (IQR: 0–19) ICU-free days ( P  = 0.025) in the early and late administration groups, respectively. The cumulative mortality at 90 days was 15.3% in the early administration group and 31.3% in the late administration group (adjusted hazard ratio 0.38; 95% confidence interval 0.13–1.09). Conclusions In patients with septic shock, early administration of PMX-HP was associated with higher mean arterial pressure and lower VIS within 48 h after ICU admission. Additionally, it may be associated with an improved clinical course, represented by more ICU-free and vasopressor/inotrope-free days. Trial registration UMIN Clinical Trial Registry on 1 November 2019 (registration no. UMIN000038302).