Clinical effects of adsorption of lipopolysaccharide in the treatment of Gram-negative severe sepsis

Introduction

Sepsis is a major cause of morbidity and mortality in intensive care clinics and the incidence is continuously increasing. Estimated mortality rates are over 30% for patients with severe sepsis and over 50% for patients with septic shock. Endotoxins, or lipopolysaccharides (LPSs), are a major component of the cell membrane of Gram-negative bacteria. LPS is well known to induce a strong response from the immune system leading to release of inflammatory mediators and occasionally sepsis, or even septic shock. The aim of our study is to investigate the clinical effects of adding treatment with the Alteco^® LPS Adsorber (Alteco Medical AB, Lund, Sweden) to standard therapy for patients with septic shock.

Methods

Our study included 12 patients with septic shock and endotoxemia randomized 1:1 to standard therapy plus LPS adsorption (adsorber group (AdG), n = 6) or standard therapy alone (reference group (RefG), n = 6). Randomization of patients will be performed using sealed envelopes.

This included five women and seven men; mean age 47.3 ± 24.8 years. All patients needed inotropic support and mechanical lung ventilation. The mean APACHE II score at start of treatment was 26.6 ± 2.3. Both groups in the study received standard therapy (Surviving Sepsis Campaign International Guidelines 2008) for patients in septic shock. For patients in the study group, treatment with the Alteco^® LPS Adsorber was added to standard therapy. The adsorber treatment was initiated immediately after inclusion in the study; that is, as soon as possible after onset of septic shock. The duration of Alteco^® LPS Adsorber treatment was 120 minutes repeated twice within 24 hours. Hemofiltration/hemoperfusion in the study group was not carried out during the perfusion. Samples for endotoxin and PCT analysis shall be taken from the arterial line. Hemodynamic parameters are registered according to routines at the clinic (PICCO technology).

Results

Hemodynamic data, laboratory results, and blood gas analysis are summarized in Table 1. LPS was significantly lower in all patients in the study group after treatment. No complications related to the use of the Alteco^® LPS Adsorber were seen and all patients in this group were discharged from the ICU after 45 to 68 days, respectively.

Table 1 Results from analyses of samples

Conclusions

We have received a statistically significant improvement in hemodynamics, oxygenation, and reduced markers of endotoxemia in group therapy with Alteco^® LPS Adsorber compared with traditional therapy. These effects were attributed with the removal of endotoxin from the systemic circulation. Only in one case using hemofiltration for acute renal failure in the study group (in the reference group in all patients), 28-day mortality was 16.7% and 66.7% respectively. Negative effects were negligible.