Mechanism and effectiveness of polymyxin B-immobilized fiber columns for removing mediators (HMBG-1, 2-arachidonoyl glycerol, anandamide, PAI-1, protein C and IL-6) in septic shock patients

Introduction

Septic shock remains a major cause of multiple organ failure with a high mortality rate. To remove an endotoxin in patient plasma, direct hemoperfusion (DHP) using a polymyxin B-immobilized fiber column (PMX; Toray Industries Inc., Tokyo Japan) was developed in Japan in 1994 and has since been used for the treatment of septic shock. The precise role of PMX is not clear.

Patients and methods

We treated 27 septic shock patients using DHP-PMX. The patients were separated into two groups for analysis: those whose systolic blood pressure (SBP) increased by more than 30 mmHg immediately after DHP-PMX (15 cases), and those whose SBP did not increase by more than 30 mmHg after DHP-PMX (12 cases). Furthermore, the patients were separated into two other groups for analysis: those whose P/F ratio increased by more than 20% immediately after DHP-PMX (15 cases), and those whose P/F ratio did not increase by more 20% after DHP-PMX (12 cases). Mediators were measured at four points: before and after DHP-PMX, and 1 day and 3 days afterward.

Results

The patient group consisted of 17 males and 10 females, 59.6 ± 12.7 years old. The average APACHE II score was 27.2 ± 9.1, and the average SOFA score was 11.7 ± 5.2 before DHP-PMX. Nineteen patients survived and eight died. When the changes in PAI-1, protein C, ATIII, IL-6 and high mobility group box protein 1 (HMGB-1) were compared between the groups, only the HMGB-1 levels had improved significantly in the SBP increased group (P = 0.0125). The SBP increased significantly after DHP-PMX in the HMGB-1-improved group (P < 0.0001). An improvement in the P/F ratio and a reduction in 2-arachidonoyl glycerol during DHP-PMX were significantly correlated (P = 0.0184).

Conclusion

We showed that the circulation dynamics of septic shock patients can be improved by reducing HMGB-1 levels and that respiratory function can be improved by reducing 2-arachidonoyl glycerol levels using DHP-PMX.