Selective adsorption of lipopolysaccharide in the complex treatment of patients with severe sepsis

Introduction

Severe sepsis and septic shock remain the most serious problem of critical care medicine with a mortality rate of 30 to 55% [1]. Several studies have demonstrated positive effects of selective adsorption of LPS on blood pressure, PaO₂/FiO₂ ratio, endotoxin removal and mortality [2, 3]. The purpose of the study was to evaluate the efficiency of using the selective adsorption of LPS, Toraymyxin - PMX-F (Toray, Japan) and Alteco^® LPS Adsorber (Alteco Medical AB, Sweden), in the complex treatment of patients with severe sepsis.

Methods

Forty-six patients with Gram-negative sepsis in the postoperative period were enrolled into the study. Toraymyxin - PMX-F was used in the PMX-F group (n = 14), while Alteco LPS adsorption was used in the Alteco LPS group (n = 32). The clinical characteristics are listed in Table 1. The SOFA score, PaO₂/FiO₂, procalcitonin (PCT), C-reactive protein (CRP), endotoxin activity assay (EAA) was noted before, 24 and 48 hours after the selective adsorption of LPS.

Table 1 Clinical characteristics of the groups

Results

At 48 hours after PMX-F, significantly decreased PCT from 17.5 (5.0; 40.9) to 7.1 (4.8; 13.0) ng/ml, P = 0.028, decreased CRP from 180 (133; 286) to 132 (68; 155) mg/l, P = 0.015 and SOFA score from 7.0 (3,0; 8.0) to 6.0 (3,0; 7.0), P = 0.007. At 24 hours after Alteco LPS, significantly decreased PCT from 8.7 (3.0; 25.9) to 4.8 (2.1; 10.0) ng/ml. The 28-day mortality rate was 14.2% (n = 2) in the PMX-F group and 31.3% (n = 10) in the Alteco LPS group.

Conclusion

The use of the LPS-selective adsorption (particularly PMX-F) in patients with severe sepsis leads to improvement of systemic inflammation and organ dysfunction.