Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival

BMC Pulmonary Medicine

Takafumi Suda¹  Shigehito Sato²  Matsuyuki Doi⁴  Soichiro Mimuro⁴  Akihiko Kato⁵  Hideo Yasuda³  Yutaro Nakamura¹  Naoki Inui⁶  Tomoyuki Fujisawa¹  Dai Hashimoto¹  Masato Kono¹  Yoshiyuki Oyama¹  Masashi Mikamo¹  Noriyuki Enomoto¹ 

[1] Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan;Department of Anesthesia and Resuscitation, University Hospital, Hamamatsu University School of Medicine, Hamamatsu, Japan;Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan;Intensive Care Unit, Hamamatsu University Hospital, Hamamatsu, Japan;Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan;Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan

关键词: PMX-DHP;    Polymyxin;    Hemoperfusion;    Idiopathic pulmonary fibrosis;    Acute exacerbation;   

Others  :  1135229
DOI  :  10.1186/s12890-015-0004-4

 received in 2014-10-13, accepted in 2015-01-20,  发布年份 2015

【 摘 要 】

Background

Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has an extremely poor prognosis and there is currently no effective treatment for this condition. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) improves oxygenation, but it is unclear whether treatment of AE-IPF with PMX-DHP affects survival. This study elucidated the effectiveness and safety of PMX-DHP for the treatment of AE-IPF.

Methods

This study included 31 patients with 41 episodes of AE-IPF. All patients received steroids. Of 31, 14 patients (20 episodes) were treated with PMX-DHP. The laboratory and physiological test results after the start of therapy and survival were retrospectively compared between patients treated with and without PMX-DHP.

Results

Patients treated with PMX-DHP had a significantly greater change in PaO₂/FiO₂ ratio (mean ± SEM, 58.2 ± 22.5 vs. 0.7 ± 13.3, p = 0.034) and a smaller change in white blood cell count (−630 ± 959 /μL vs. 4500 ± 1190 /μL, p = 0.002) after 2 days of treatment than patients treated without PMX-DHP. The 12-month survival rate was significantly higher in patients treated with PMX-DHP (48.2% vs. 5.9%, p = 0.041). PMX-DHP was effective in patients with more severe underlying disease (GAP stages II or III; 12-month survival rate 57.1% with PMX-DHP vs. 0% without PMX-DHP, p = 0.021). Treatment with PMX-DHP was an independent predictor of better prognosis (hazard ratio 0.345, p = 0.037). Mild pulmonary thromboembolism occurred in one patient treated with PMX-DHP.

Conclusions

Treatment of AE-IPF with PMX-DHP is tolerable and improves 12-month survival.

【 授权许可】

   
2015 Enomoto et al.; licensee BioMed Central.

【 图 表 】

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