Lipopolysaccharide adsorber in abdominal septic shock

Introduction

Polymyxin-B hemoperfusion has been shown to lower mortality in sepsis [1]. The effects of a new endotoxin adsorber (Alteco LPS Adsorber; Alteco Medical AB, Lund, Sweden) on the length of noradrenaline (NA) treatment and lipopolysaccharide blood levels in abdominal septic shock were evaluated.

Methods

Following consent a 2-hour hemoperfusion with LPS adsorber was began in five patients [2]. Sepsis guidelines were followed [3]. Two historical controls per case were selected.

Results

The mean total duration of NA infusion was 46 hours shorter in the adsorber group compared with the control group (95% CI = -104 hours to 12 hours, P = 0.165) (Table 1). The average length of NA infusion was 17.4 ± 6.8 hours (5.8 to 23.8 hours) following the start of adsorption treatment. The level of LPS decreased in all but one study patient and all were without NA at 24 hours. The mean Sequential Organ Failure Assessment decrease was 3.4 ± 1.7 from baseline to 24 hours post treatment The average length of hospital stay was 3.4 days shorter in the adsorber group (95% CI of the difference, -21.7 to 14.8 days, P = 0.881). All study patients were alive on day 28 and one control died in the hospital.

Table 1 Clinical characteristics of the study patients and the controls

Conclusion

Single 2-hour LPS hemoperfusion was associated with a rapid decrease in NA dose, reversal of septic shock, and decrease in organ dysfunctions and LPS concentrations. The total duration of NA infusion and hospital stay were shorter compared with historical controls, but the difference was not statistically significant in this small study.