Influence of endotoxin adsorption to immunity

The influence of direct hemoperfusion using polymyxin B immobilized fiber (PMX) to immunity was studied in severe septic patients with organ dysfunction. Thirty-four cases whose mean age and APACHE II were 59 years and 23 were treated by the PMX in 50 times. They were divided into the detectable (≥ 10 pg/ml, n = 27) and non-detectable (n = 23) endotoxin group, analyzed before PMX by colorimetric limulus test with chromogenic substrate (Toxicolor). After PMX, mean arterial pressure and systemic vascular resistance index were significantly increased in both groups. Endotoxin, neutrophils and monocytes were significantly decreased from 76.4 ± 19.5 to 64.8 ± 17.8 pg/ml (P = 0.0158), from 14810 ± 2020 to 9990 ± 1660/mm³ (P = 0.0002), and from 688 ± 103 to 512 ± 99/mm³ (P = 0.0087) respectively in the D group, while lymphocytes were decreased not significantly in both groups. Furthermore IL-6 was significantly decreased from 958 ± 437 to 722 ± 296 pg/ml (n = 37, P = 0.0495), IL-8 and CD4 were significantly increased from 162 ± 80 to 195 ± 114 pg/ml (n = 31, P = 0.0456) and from 31 ± 4 to 34 ± 3% (n = 14, P = 0.0091) respectively, but TNFα and IL-1β did not change significantly. These results indicated that the therapy with PMX in severe sepsis could be going to end the response of innate immunity and induce the adaptive immunity, so that it would be helpful for hemodynamic stability.