Clinical effects of polymyxin B immobilised fiber with direct hemoperfusion for the patients of severe sepsis or septic shock caused by intra-abdominal infections

Introduction

The endotoxin adsorption method polymyxin B immobilised fiber with direct hemoperfusion (PMX-DHP) has been used for treatment of patients with severe sepsis and septic shock primarily caused by Gram-negative infections in Japan [1]. One hundred and twenty-six septic patients who had severe sepsis or septic shock due to intra-abdominal infections were treated with PMX-DHP.

Methods

These patients were separated into two groups: whose who survived for at least 28 days after the start of PMX-DHP therapy (survival: 85 cases) and those who did not (nonsurvival: 41 cases). Background factors and inflammatory mediators were examined in each group. PMX-DHP was assessed with the changes of clinical parameters (heart rate, systolic arterial pressure, mean arterial pressure, PaO₂/FiO₂) and various cytokines (TNFα IL-6, IL-8, IL-1ra, PAI-1). Sepsis was diagnosed according to the criteria of the American College of Chest Physicians/Critical Care Medicine Consensus Conference Committee.

Results

A total of 91.7% of survival cases were principally treated with surgical procedure. On demographic data, Goris's multiple organ failure score only showed significant differences between the groups (survival cases: 5.8 ± 2.8, nonsurvival cases: 8.0 ± 2.6, P < 0.05). Procalcitonin (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 67.3 ± 109.6 ng/ml before PMX-DHP and significantly decreased to 54.7 ± 82.1 ng/ml immediately 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 for the patients with severe sepsis or septic shock caused by intra-abdominal infections can improve hemodynamic changes and pulmonary oxygenation, and also reduce systemic inflammatory cytokines and serum PCT in the survival group.