Lipopolysaccharide adsorption in combined therapy of patients with severe sepsis

Introduction

Sepsis is a serious problem of ICUs due to high mortality. Adsorption of lipopolysaccharide (LPS) circulating in blood at Gram-negative infections may prevent systemic inflammatory cascade progressing. The aim was to study LPS adsorption efficacy in combined therapy of patients with severe Gram-negative sepsis.

Methods

Nine surgical patients with severe sepsis were enrolled into the study: six patients underwent cardiac surgery with cardiopulmonary bypass, three patients with severe pancreatitis. The mean age was 50.8 ± 4.7 years. All patients required inotropic support, eight patients were on mechanical ventilation. The mean APACHE II score was 21.1 ± 3.8 points. Each patient received two LPS adsorption procedures (LPS-adsorber; Alteco Medical AB, Sweden). Each session takes 120 minutes. The blood flow rate was 100–150 ml/min, anticoagulation was heparin 4–10 U/kg/hour. In addition to routine tests, detection of LPS (LAL-test; Cembrex, USA), proinflammatory cytokines TNFα, IL-1β, IL-6 (IFA; Bends Med. Systems, Austria) and procalcitonin (PCT) concentrations (PCT LIA; BRAHMS AG, Germany) were performed. The data are expressed as the median and 25th and 75th percentiles and were compared by Mann–Whitney U test; P < 0.05 was considered statistically significant.

Results

Decreasing LPS, proinflammatory cytokines and PCT concentrations after LPS adsorption were observed (see Figure 1). Insignificant and short-term (10–15 min) depression of the arterial pressure and systemic vascular resistance with unchanged cardiac output was noted at the beginning of the first procedure of LPS adsorption. Stabilization of hemodynamics was reached by temporary increasing inotropic support. Despite the combined treatment 6/9 (67%) patients died due to cardiac failure (n = 3) and multiorgan failure (n = 3) progressing.

Figure 1

Dynamics of lipopolysaccharide (LPS), cytokines and procalcitonin (PCT).

Conclusion

Our experience of LPS adsorption shows evidence of potential efficacy of this method in combined therapy for severe Gram-negative sepsis. Further investigations are required.