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Relationship between effect of polymyxin B-immobilized fiber and high-mobility group box-1 protein in septic shock patients
Critical Care volume 10, Article number: P291 (2006)
Septic shock remains a major cause of multiple organ failure with a high mortality rate. A relationship between high-mobility group box-1 protein (HMGB-1) and septic shock was recently reported. On the other hand, treatment of direct hemoperfusion with polymyxin B-immobilized fiber column (PMX; Toray Industries Inc., Tokyo Japan) was developed in Japan in 1994 and has been used for treatment of septic shock of endotoxemia. Reduction of the serum endotoxin level by PMX has been recognized. Clinical effectiveness data of this column have also been reported, for example increasing the systolic blood pressure and improvement of the systemic vascular resistance index. Although a decrease of inflammatory cytokine after direct hemoperfusion with PMX has been reported, the detailed mechanism of PMX is not known.
Patients and methods
We treated 10 septic shock cases by direct hemoperfusion with PMX. All patients were diagnosed with sepsis according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference and required intensive care for unstable circulation state. We measured the HMGB-1 level at three points; before direct hemoperfusion with PMX, after direct hemoperfusion with PMX and 12 hours afterward. We also examined clinical data; systolic blood pressure and Sepsis-related Organ Failure Assessment (SOFA) score.
There were five peritonitis cases and five severe pneumonia cases. Five cases admitted the decrease of the HMGB-1 value immediately before and after direct hemoperfusion with PMX implementation. Especially in five peritonitis cases, the HMGB-1 value at 12 hours compared with that before direct hemoperfusion with PMX implementation had decreased in all cases. Increasing systolic blood pressure was confirmed in three cases and a decrease of HMGB-1 was admitted in five cases. Before and after direct hemoperfusion with PMX, there was significant correlation (P = 0.0384) of systolic blood pressure reaction and HMGB-1 decrease.
The possibility of the adsorption of HMGB-1 by direct hemoperfusion with PMX has been shown. Also, the possibility that the adsorption of HMGB-1 was the factor of the morbid state improvement by direct hemoperfusion with PMX was suggested.
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Sakamoto, Y., Mashiko, K., Matsumoto, H. et al. Relationship between effect of polymyxin B-immobilized fiber and high-mobility group box-1 protein in septic shock patients. Crit Care 10, P291 (2006). https://doi.org/10.1186/cc4638
- Septic Shock
- Septic Shock Patient
- Systemic Vascular Resistance Index
- Blood Pressure Reaction
- Direct Hemoperfusion