Acute Crit Care.  2021 May;36(2):126-132. 10.4266/acc.2021.00073.

The effects of direct hemoperfusion with polymyxin B-immobilized fiber in patients with acute exacerbation of interstitial lung disease

• Lee JH
• Park JH
• Kim HJ
• Kim HK
• Jang JH
• Kim YK
• Park BS
• Park SH
• Kim IH
• Kim SH
• Heo W
• Jang HJ

• KMID: 2516260
• DOI: http://doi.org/10.4266/acc.2021.00073

Abstract

Background
Acute exacerbation of interstitial lung disease (AE-ILD) causes clinically significant deterioration and has an extremely poor prognosis with high mortality. Recently, several studies reported the effectiveness of direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) in patients with AE-ILD as a potential therapy. This study describes the clinical effectiveness and safety of PMX-DHP in patients with AE-ILD.
Methods
We retrospectively reviewed the medical records of 10 patients (11 episodes) with AE-ILD treated with PMX-DHP from January 2018 to June 2019. We compared laboratory and physiologic data of the ratio of partial pressure arterial oxygen to fraction of inspired oxygen (P/F ratio) and level of inflammatory markers before and after implementation of PMX-DHP.
Results
Ten patients were included according to the 2016 revised definition of acute exacerbation of idiopathic pulmonary fibrosis (IPF). Nine patients had IPF and one patient had fibrotic nonspecific interstitial pneumonia. Most patients (90.9%) were treated with a steroid pulse, and four patients (36.4%) were treated with an immunosuppressant. The median number of PMX-DHP cycles was 2, and the median duration of each cycle was 6 hours. After PMX-DHP, the mean P/F ratio improved (86 [range, 63–106] vs. 145 [86–260], P=0.030) and interleukin-6 and c-reactive protein decreased (79 [35–640] vs. 10 [5–25], P=0.018 and 14 [4–21] vs. 5 [2–6], P=0.019, respectively). The 30-day mortality rate was 27.3% and the 90-day mortality rate was 72.7%.
Conclusions
PMX-DHP treatment improved P/F ratio and reduced inflammatory markers in AE-ILD patients.

Keyword

acute exacerbation; idiopathic pulmonary fibrosis; interstitial lung disease; polymyxin B-immobilized fiber column

Figure

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  Figure 1. Comparison of white blood cell (WBC), C-reactive protein (CRP), interleukin (IL)-6, and the ratio of partial pressure arterial oxygen to fraction of inspired oxygen (P/F ratio) at 48 hours after polymyxin B-immobilized fiber column (PMX-DHP) treatment. (A) WBC count, (B) CRP, (C) IL-6, (D) P/F ratio. Serum levels of CRP and IL-6 were decreased after 48 hours of PMX-DHP. The P/F ratio was improved after 48 hours of PMX-DHP. There was no change in WBC count at after 48 hours of PMX-DHP. The horizontal bars indicate median values.

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  Figure 2. Kaplan-Meier survival curve for patients with acute exacerbation of interstitial lung disease (AE-ILD) treated with polymyxin B-immobilized fiber column (PMX-DHP). In patients with AE-ILD treated by PMX-DHP, the 30-day mortality rate was 27.3% and the 90-day mortality rate was 72.7%.

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