Changes in Oxygenation and Serological Markers in Acute Exacerbation of Interstitial Lung Disease Treated with Polymyxin B Hemoperfusion
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Selection
2.2. Treatment of PMX-DHP
2.3. Statistical Analysis
3. Results
3.1. Patients’ Baseline Characteristics
3.2. Patient’s Treatment and Clinical Outcomes
3.3. Vital Signs and Laboratory Data before and after PMX-DHP
3.4. Factors Associated with Patients’ 90-Day Mortality
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Antoniou, K.M.; Margaritopoulos, G.A.; Tomassetti, S.; Bonella, F.; Costabel, U.; Poletti, V. Interstitial lung disease. Eur. Respir. Rev. 2014, 23, 40–54. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bando, M.; Sugiyama, Y.; Azuma, A.; Ebina, M.; Taniguchi, H.; Taguchi, Y.; Takahashi, H.; Homma, S.; Nukiwa, T.; Kudoh, S. A prospective survey of idiopathic interstitial pneumonias in a web registry in Japan. Respir. Investig. 2015, 53, 51–59. [Google Scholar] [CrossRef] [PubMed]
- Al-Hameed, F.M.; Sharma, S. Outcome of patients admitted to the intensive care unit for acute exacerbation of idiopathic pulmonary fibrosis. Can. Respir. J. 2004, 11, 117–122. [Google Scholar] [CrossRef] [PubMed]
- Song, J.W.; Hong, S.B.; Lim, C.M.; Koh, Y.; Kim, D.S. Acute exacerbation of idiopathic pulmonary fibrosis: Incidence, risk factors and outcome. Eur. Respir. J. 2011, 37, 356–363. [Google Scholar] [CrossRef] [PubMed]
- Collard, H.R.; Ryerson, C.J.; Corte, T.J.; Jenkins, G.; Kondoh, Y.; Lederer, D.J.; Lee, J.S.; Maher, T.M.; Wells, A.U.; Antoniou, K.M.; et al. Acute Exacerbation of Idiopathic Pulmonary Fibrosis. An International Working Group Report. Am. J. Respir. Crit. Care Med. 2016, 194, 265–275. [Google Scholar] [CrossRef]
- Suzuki, A.; Kondoh, Y.; Brown, K.K.; Johkoh, T.; Kataoka, K.; Fukuoka, J.; Kimura, T.; Matsuda, T.; Yokoyama, T.; Fukihara, J.; et al. Acute exacerbations of fibrotic interstitial lung diseases. Respirology 2020, 25, 525–534. [Google Scholar] [CrossRef]
- Montesi, S.B.; Fisher, J.H.; Martinez, F.J.; Selman, M.; Pardo, A.; Johannson, K.A. Update in Interstitial Lung Disease 2019. Am. J. Respir. Crit. Care Med. 2020, 202, 500–507. [Google Scholar] [CrossRef]
- Churg, A.; Muller, N.L.; Silva, C.I.; Wright, J.L. Acute exacerbation (acute lung injury of unknown cause) in UIP and other forms of fibrotic interstitial pneumonias. Am. J. Surg. Pathol. 2007, 31, 277–284. [Google Scholar] [CrossRef]
- Shoji, H.; Tani, T.; Hanasawa, K.; Kodama, M. Extracorporeal endotoxin removal by polymyxin B immobilized fiber cartridge: Designing and antiendotoxin efficacy in the clinical application. Ther. Apher. Off. J. Int. Soc. Apher. Jpn. Soc. Apher. 1998, 2, 3–12. [Google Scholar] [CrossRef]
- Oishi, K.; Mimura-Kimura, Y.; Miyasho, T.; Aoe, K.; Ogata, Y.; Katayama, H.; Murata, Y.; Ueoka, H.; Matsumoto, T.; Mimura, Y. Association between cytokine removal by polymyxin B hemoperfusion and improved pulmonary oxygenation in patients with acute exacerbation of idiopathic pulmonary fibrosis. Cytokine 2013, 61, 84–89. [Google Scholar] [CrossRef]
- Shoji, H. Extracorporeal endotoxin removal for the treatment of sepsis: Endotoxin adsorption cartridge (Toraymyxin). Ther. Apher. Dial. Off. Peer-Rev. J. Int. Soc. Apher. Jpn. Soc. Apher. Jpn. Soc. Dial. Ther. 2003, 7, 108–114. [Google Scholar]
- Tsushima, K.; Kubo, K.; Koizumi, T.; Yamamoto, H.; Fujimoto, K.; Hora, K.; Kan-Nou, Y. Direct hemoperfusion using a polymyxin B immobilized column improves acute respiratory distress syndrome. J. Clin. Apher. 2002, 17, 97–102. [Google Scholar] [CrossRef] [PubMed]
- Kushi, H.; Miki, T.; Okamaoto, K.; Nakahara, J.; Saito, T.; Tanjoh, K. Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation. Crit. Care 2005, 9, R653–R661. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Seo, Y.; Abe, S.; Kurahara, M.; Okada, D.; Saito, Y.; Usuki, J.; Azuma, A.; Koizumi, K.; Kudoh, S. Beneficial effect of polymyxin B-immobilized fiber column (PMX) hemoperfusion treatment on acute exacerbation of idiopathic pulmonary fibrosis. Intern. Med. 2006, 45, 1033–1038. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hara, S.; Ishimoto, H.; Sakamoto, N.; Mukae, H.; Kakugawa, T.; Ishimatsu, Y.; Mine, M.; Kohno, S. Direct hemoperfusion using immobilized polymyxin B in patients with rapidly progressive interstitial pneumonias: A retrospective study. Respiration 2011, 81, 107–117. [Google Scholar] [CrossRef] [PubMed]
- Abe, S.; Seo, Y.; Hayashi, H.; Matsuda, K.; Usuki, J.; Azuma, A.; Kudoh, S.; Gemma, A. Neutrophil adsorption by polymyxin B-immobilized fiber column for acute exacerbation in patients with interstitial pneumonia: A pilot study. Blood Purif. 2010, 29, 321–326. [Google Scholar] [CrossRef] [PubMed]
- Abe, S.; Azuma, A.; Mukae, H.; Ogura, T.; Taniguchi, H.; Bando, M.; Sugiyama, Y. Polymyxin B-immobilized fiber column (PMX) treatment for idiopathic pulmonary fibrosis with acute exacerbation: A multicenter retrospective analysis. Intern. Med. 2012, 51, 1487–1491. [Google Scholar] [CrossRef] [Green Version]
- Enomoto, N.; Suda, T.; Uto, T.; Kato, M.; Kaida, Y.; Ozawa, Y.; Miyazaki, H.; Kuroishi, S.; Hashimoto, D.; Naito, T.; et al. Possible therapeutic effect of direct haemoperfusion with a polymyxin B immobilized fibre column (PMX-DHP) on pulmonary oxygenation in acute exacerbations of interstitial pneumonia. Respirology 2008, 13, 452–460. [Google Scholar] [CrossRef]
- Takada, T.; Asakawa, K.; Sakagami, T.; Moriyama, H.; Kazama, J.; Suzuki, E.; Narita, I. Effects of direct hemoperfusion with polymyxin B-immobilized fiber on rapidly progressive interstitial lung diseases. Intern. Med. 2014, 53, 1921–1926. [Google Scholar] [CrossRef] [Green Version]
- Enomoto, N.; Mikamo, M.; Oyama, Y.; Kono, M.; Hashimoto, D.; Fujisawa, T.; Inui, N.; Nakamura, Y.; Yasuda, H.; Kato, A.; et al. Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival. BMC Pulm. Med. 2015, 15, 15. [Google Scholar] [CrossRef] [Green Version]
- Oishi, K.; Aoe, K.; Mimura, Y.; Murata, Y.; Sakamoto, K.; Koutoku, W.; Matsumoto, T.; Ueoka, H.; Yano, M. Survival from an Acute Exacerbation of Idiopathic Pulmonary Fibrosis with or without Direct Hemoperfusion with a Polymyxin B-immobilized Fiber Column: A Retrospective Analysis. Intern. Med. 2016, 55, 3551–3559. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lee, J.H.; Park, J.H.; Kim, H.J.; Kim, H.K.; Jang, J.H.; Kim, Y.K.; Park, B.S.; Park, S.H.; Kim, I.H.; Kim, S.H.; et al. The effects of direct hemoperfusion with polymyxin B-immobilized fiber in patients with acute exacerbation of interstitial lung disease. Acute Crit. Care 2021, 36, 126–132. [Google Scholar] [CrossRef] [PubMed]
- Yamazoe, M.; Tomioka, H. Acute exacerbation of idiopathic pulmonary fibrosis: A 10-year single-centre retrospective study. BMJ Open Respir. Res. 2018, 5, e000342. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Papiris, S.A.; Tomos, I.P.; Karakatsani, A.; Spathis, A.; Korbila, I.; Analitis, A.; Kolilekas, L.; Kagouridis, K.; Loukides, S.; Karakitsos, P.; et al. High levels of IL-6 and IL-8 characterize early-on idiopathic pulmonary fibrosis acute exacerbations. Cytokine 2018, 102, 168–172. [Google Scholar] [CrossRef] [PubMed]
- Lee, J.H.; Jang, J.H.; Park, J.H.; Jang, H.J.; Park, C.S.; Lee, S.; Kim, S.H.; Kim, J.Y.; Kim, H.K. The role of interleukin-6 as a prognostic biomarker for predicting acute exacerbation in interstitial lung diseases. PLoS ONE 2021, 16, e0255365. [Google Scholar] [CrossRef]
- Sand, J.M.B.; Tanino, Y.; Karsdal, M.A.; Nikaido, T.; Misa, K.; Sato, Y.; Togawa, R.; Wang, X.; Leeming, D.J.; Munakata, M. A Serological Biomarker of Versican Degradation is Associated with Mortality Following Acute Exacerbations of Idiopathic Interstitial Pneumonia. Respir. Res. 2018, 19, 82. [Google Scholar] [CrossRef] [Green Version]
- Kamiya, H.; Panlaqui, O.M. Systematic review and meta-analysis of prognostic factors of acute exacerbation of idiopathic pulmonary fibrosis. BMJ Open 2020, 10, e035420. [Google Scholar] [CrossRef]
- Hachisu, Y.; Murata, K.; Takei, K.; Tsuchiya, T.; Tsurumaki, H.; Koga, Y.; Horie, T.; Takise, A.; Hisada, T. Possible Serological Markers to Predict Mortality in Acute Exacerbation of Idiopathic Pulmonary Fibrosis. Medicina 2019, 55, 132. [Google Scholar] [CrossRef] [Green Version]
- Lain, W.L.; Chang, S.C.; Chen, W.C. Outcome and prognostic factors of interstitial lung disease patients with acute respiratory failure in the intensive care unit. Ther. Adv. Respir. Dis. 2020, 14, 1753466620926956. [Google Scholar] [CrossRef]
- Huapaya, J.A.; Wilfong, E.M.; Harden, C.T.; Brower, R.G.; Danoff, S.K. Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit. Eur. Respir. Rev. 2018, 27, 150. [Google Scholar] [CrossRef]
- Fernández-Pérez, E.R.; Yilmaz, M.; Jenad, H.; Daniels, C.E.; Ryu, J.H.; Hubmayr, R.D.; Gajic, O. Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease. Chest 2008, 133, 1113–1119. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Baseline Characteristics | Value |
---|---|
Age, years | 66 (60–77) |
Male (%) | 18 (81.8) |
Body mass index, kg/m2 | 23.8 (21.7–24.9) |
Idiopathic pulmonary fibrosis | 11 (50.0) |
ILD excluding IPF | 11 (50.0) |
Underlying disease | |
Hypertension | 11 (50.0) |
Diabetes mellitus | 8 (36.4) |
Solid tumor | 3 (13.6) |
Hematologic malignancy | 1 (4.5) |
Chronic kidney disease | 1 (4.5) |
Cerebrovascular accident | 2 (9.1) |
Medication prior to acute exacerbation | |
Steroid | 4 (18.2) |
Pirfenidone | 6 (27.3) |
Cyclophosphamide | 2 (9.1) |
APACHE II score | 17.5 (11.0–22.0) |
Pulmonary function test (n = 16) | |
FVC, % predicted | 69.5 (54.0–79.3) |
FEV1, % predicted | 82.0 (61.8–93.3) |
DLCO, % predicted | 53.5 (38.3–67.8) |
Treatment and Outcome | Value |
---|---|
Medical therapy used for AE | |
Methylprednisolone | 22 (100.0) |
Antibiotics | 22 (100.0) |
PMX-DHP therapy within 48 h of AE of ILD | 16 (72.7) |
28-day mortality | 10 (45.5) |
90-day mortality | 16 (72.7) |
Invasive mechanical ventilation | 13 (59.1) |
Duration of ventilator, days | 9.0 (5.0–16.5) |
Hospital stay, days | 21.0 (13.5–30.0) |
Survival days from 1st PMX-DMP therapy | 15.0 (7.3–26.0) |
Value | Baseline | 24 h | 48 h | |||||
---|---|---|---|---|---|---|---|---|
Median, IQR | n | Median, IQR | n | p-Value | Median, IQR | n | p-Value | |
Lab | ||||||||
pH | 7.43 (7.35–7.47) | 22 | 7.43 (7.37–7.46) | 22 | 0.944 | 7.42 (7.37–7.45) | 22 | 0.987 |
PaCO2, mmHg | 41.0 (34.8–49.8) | 22 | 39.5 (34.8–48.0) | 22 | 0.134 | 39.5 (35.5–44.0) | 22 | 0.158 |
PaO2, mmHg | 74.0 (63.8–99.3) | 22 | 102.5 (79.8–126.8) | 22 | 0.046 | 110.0 (86.5–120.5) | 22 | 0.011 |
P/F ratio, mmHg | 116.3 (88.5–134.3) | 22 | 168.6 (115.5–226.8) | 22 | 0.001 | 181.6 (108.9–232.0) | 22 | 0.003 |
WBC, ×103/µL | 13.9 (10.8–22.8) | 22 | 10.3 (7.2–18.2) | 22 | 0.001 | 8.3 (5.1–16.4) | 22 | 0.002 |
Hb, g/dL | 11.9 (10.5–13.6) | 22 | 10.7 (9.8–13.0) | 22 | 0.020 | 11.1 (9.5–12.7) | 22 | 0.011 |
Platelet, ×103/µL | 239.0 (180.3–279.5) | 22 | 191.5 (122.8–248.8) | 22 | <0.001 | 167.5 (74.0–234.0) | 22 | <0.001 |
CRP, mg/dL | 11.6 (3.8–20.7) | 22 | 10.6 (3.7–14.5) | 20 | 0.159 | 5.8 (2.9–10.7) | 17 | 0.049 |
IL-6, pg/mL | 46.8 (8.8–277.8) | 22 | 19.3 (6.2–51.9) | 22 | 0.014 | 24.7 (2.3–144.8) | 14 | 0.778 |
Vital sign | ||||||||
Mean BP, mmHg | 88.5 (82.8–95.0) | 22 | 82.5 (78.0–92.5) | 22 | 0.445 | 86.0 (78.8–93.5) | 22 | 0.626 |
Heart rate, beats/min | 99 (86–120) | 22 | 94 (82–114) | 22 | 0.051 | 91 (71–117) | 22 | 0.041 |
Respiratory rate, beats/min | 25 (22–28) | 22 | 23 (20–27) | 22 | 0.808 | 24 (20–29) | 22 | 0.191 |
Body temperature, °C | 37.1 (36.8–37.3) | 22 | 36.9 (36.6–37.3) | 22 | 0.296 | 36.8 (36.5–37.0) | 22 | 0.012 |
Parameters | Odds Ratio | 95% Confidence Interval | p-Value |
---|---|---|---|
Age | 1.056 | 0.968–1.151 | 0.218 |
Male | 4.023 | 0.614–26.378 | 0.147 |
Body mass index, kg/m2 | 0.664 | 0.439–1.005 | 0.053 |
Initial APACHE II scores | 1.267 | 1.069–1.501 | 0.006 |
Initial laboratory data | |||
White blood cell | 0.982 | 0.882–1.095 | 0.747 |
C-reactive protein | 0.982 | 0.922–1.046 | 0.576 |
Interleukin-6 | 0.999 | 0.998–1.001 | 0.397 |
P/F ratio | 0.951 | 0.902–1.002 | 0.061 |
PMX-DHP therapy within 48 h of AE of ILD | 1.212 | 0.200–7.336 | 0.834 |
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Lee, S.-I.; Chung, C.; Park, D.; Kang, D.H.; Lee, J.E. Changes in Oxygenation and Serological Markers in Acute Exacerbation of Interstitial Lung Disease Treated with Polymyxin B Hemoperfusion. J. Clin. Med. 2022, 11, 2485. https://doi.org/10.3390/jcm11092485
Lee S-I, Chung C, Park D, Kang DH, Lee JE. Changes in Oxygenation and Serological Markers in Acute Exacerbation of Interstitial Lung Disease Treated with Polymyxin B Hemoperfusion. Journal of Clinical Medicine. 2022; 11(9):2485. https://doi.org/10.3390/jcm11092485
Chicago/Turabian StyleLee, Song-I, Chaeuk Chung, Dongil Park, Da Hyun Kang, and Jeong Eun Lee. 2022. "Changes in Oxygenation and Serological Markers in Acute Exacerbation of Interstitial Lung Disease Treated with Polymyxin B Hemoperfusion" Journal of Clinical Medicine 11, no. 9: 2485. https://doi.org/10.3390/jcm11092485