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.