Skip to main content

Changes in procalcitonin in septic shock patients treated with endotoxin adsorption therapy

Introduction

The endotoxin adsorption method (PMX-DHP: Toray Industries, Inc., Tokyo, Japan) is used for treatment of patients with sepsis and septic shock primarily caused by Gram-negative infections in Japan. Procalcitonin (PCT) levels may be a good marker of infection and levels exceeding 10 ng/ml occur almost exclusively in severe sepsis. The aim of this study was to evaluate PMX-DHP for severe sepsis or septic shock patients according to PCT values. Patients were classified as a group in which PCT is higher than 10 ng/ml (H group) or a group in which PCT is lower than 10 ng/ml (L group).

Patients and methods

This mode of blood purification is principally applied on direct hemoperfusion therapy. Sixty-seven patients (40 in H group, 27 in L group) were treated with PMX-DHP. Sepsis was diagnosed according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. The following parameters (tumor necrosis factor alpha, IL-6, IL-8, IL-1ra, ICAM-1, PAI-1 and PCT) were measured just before and immediately after PMX-DHP. PCT was measured by immunoluminometric assay (LUMI test PCT; BRAHMS Diagnostica, Berlin, Germany).

Results

APACHE II score in the H group was 26.7 ± 7.6 and in the L group was 24.7 ± 9.2, respectively. SOFA score in the H group was 11.2 ± 3.8 and in the L group was 11.3 ± 4.2. The 28-day all-cause mortality rate in the H group was 30% and was 33% in the L group. These were no significant differences between the groups. IL-6, IL-8, and IL-1ra in H group were remarkably higher than in the L group. (Median IL-6, IL-8, and IL-1ra in H group were 7580 pg/ml, 646 pg/ml, 55,000 pg/ml, respectively, and in L group were 462 pg/ml, 40 pg/ml, 3650 pg/ml, respectively.) PCT in the H group showed a tendency to decline from 108 ± 120 ng/ml to 94 ± 98 ng/ml before and after PMX-DHP. Especially, PCT of the survival group in H group showed a significant decrease from 119 ± 138 ng/ml to 93 ± 102 ng/ml (P < 0.02). On the other hand, PCT of the nonsurvival group in H group increased from 83 ± 58 ng/ml to 96 ± 91 ng/ml.

Discussion

Serum PCT values were less than 0.1 ng/ml in healthy individuals, but markedly increased, mostly due to extra-thyroid production in cases of severe infection. Recent findings suggest that sources of PCT may include liver cells and monocytes/ macrophages. PCT is consistently increased after endotoxin injection, suggesting an association of endotoxin with septic shock and high PCT serum concentration.

Conclusion

Our results may suggest that PMX-DHP can reduce various cytokines and serum PCT in the survival group.

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ikeda, T., Ikeda, K., Nagura, M. et al. Changes in procalcitonin in septic shock patients treated with endotoxin adsorption therapy. Crit Care 9, P165 (2005). https://doi.org/10.1186/cc3228

Download citation

Keywords

  • Severe Sepsis
  • Procalcitonin
  • Septic Shock Patient
  • Nonsurvival Group
  • Direct Hemoperfusion