Endotoxin adsorption method may affect serum procalcitonin

Introduction

When septic patients progress to endotoxin shock, they present a high mortality rate. The mortality rate of septic patients with multiple organ failure has been reported to be 30–80%. The endotoxin adsorption method (PMX-DHP: Toray Industries, Inc., Tokyo, Japan) has been used for treatment of patients with severe sepsis and septic shock primarily caused by Gram-negative infections in Japan. We also reported that PMX-DHP removed plasma endotoxin and improved hemodynamic parameters in clinical trials [1]. The purpose of this study was to assess the changes of procalcitonin (PCT) values during PMX-DHP.

Methods

The retrospective study was carried out in our ICU. In this study, 68 septic patients who had multiple organ failure due to intra-abdominal infection were treated with PMX-DHP. Sepsis was diagnosed according to the criteria of the ACCP/SCCM Consensus Conference Committee. These patients were separated into two groups: those who survived for at least 28 days after the start of PMX-DHP therapy (S group; 49 patients), and those who did not (nonsurvival group; 19 patients). Background factors and inflammatory mediators were examined in each group. PCT was measured by immunoluminometric assay before and after PMX-DHP and 24 hours later. The luminometer used was an Autolumat LB953 (Berthord, Bad Wildbad, Germany). Endotoxin (kinetic turbidimetric method) was also measured just before and immediately after PMX-DHP.

Results

The 28-day survival rate was 72.1% (49 survivors, 19 nonsurvivors). The APACHE II scores were 22.0 ± 8.3 and 28.3 ± 7.0 and the Sequential Organ Failure Assessment scores were 9.1 ± 3.9 and 11.1 ± 2.8 in the survival and nonsurvival groups, respectively, showing significantly higher scores in the nonsurvival group. PCT before PMX-DHP in all patients was 59.1 ± 97.2 ng/ml and tended to decrease 54.7 ± 81.7 ng/ml after PMX-DHP. PCT was 59.4 ± 109.4 ng/ml before PMX-DHP and significantly decreased to 42.2 ± 67.4 ng/ml at 24 hours after PMX-DHP in the survival group, but it did not change significantly in the nonsurvival group. There was a significant correlation between endotoxin and PCT (r = 0.527, P < 0.001).

Conclusion

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