Ultra‐Long Polymyxin B Hemoperfusion and Its Effect on Vasopressor Dosage and Organ Dysfunction in Patients With Septic Shock Requiring High‐Dose Norepinephrine: A Post Hoc Analysis of a Prospective Cohort Study

Background Prolonged duration of polymyxin B hemoperfusion (PMX‐HP) for septic shock is not widely investigated. Methods We used BEAT‐SHOCK, a prospective registry including 309 adult patients with septic shock requiring high‐dose norepinephrine (≥ 0.2 μg/kg/min). Our post hoc analysis included 82 patients that underwent PMX‐HP, dichotomized into either the ultra‐long PMX‐HP group (first session duration ≥ 12 h; n = 53) or the non‐ultra‐long PMX‐HP group (< 12 h; n = 29). The primary outcomes were changes in vasopressor/inotrope dosage, represented by vasoactive‐inotropic score (VIS), and sequential organ failure assessment (SOFA) score from baseline to day 3. Results The median durations of the first PMX‐HP session in the ultra‐long and non‐ultra‐long PMX‐HP groups were 1290 and 358 min, respectively. Their median baseline VIS was 38.3 (IQR 26.0–49.5) in the ultra‐long group, 38.1 (IQR 30.9–55.6) in the non‐ultra‐long PMX‐HP group. The median baseline SOFA score was 11 (IQR 9–13) in both groups. The changes in these scores from baseline to day 3 did not differ between them (adjusted difference −3.8 [95% confidence interval −9.0 to 11.3] for VIS and −0.0 [95% confidence interval −1.5 to 1.5] for SOFA score). The 90‐day mortality rate was 24.7% in the ultra‐long PMX‐HP group and 21.1% in the non‐ultra‐long PMX‐HP group (adjusted hazard ratio 1.35; 95% confidence interval 0.49–3.69). Conclusions Ultra‐prolonged PMX‐HP for ≥ 12 h was not associated with a greater reduction in vasopressor/inotrope dosage or improvement in organ dysfunction on day 3 than PMX‐HP < 12 h in our patients with septic shock without endotoxin monitoring. Trial Registration UMIN Clinical Trial Registry on 1 November 2019 (registration no. UMIN000038302)