Skip to main content

Re-evaluation of direct hemoperfusion with polymyxin-B immobilized fiber for severe sepsis and septic shock


The equivalency of continuous venovenous hemofiltration and intermittent hemodialysis (2B) was described as a key recommendation of the Surviving Sepsis Campaign guidelines in 2008. However, there are some discrepancies associated with the evaluation of blood purification in severe sepsis and septic shock in Japan. Direct hemoperfusion with polymyxin-B immobilized fiber (PMX-DHP), developed and currently in use in Japan, has not yet been evaluated abroad. We performed a retrospective study to re-evaluate PMX-DHP for severe sepsis or septic shock patients in our ICU.


We enrolled 302 patients (survival (S) group: 201, nonsurvival (NS) group: 101) in whom PMX-DHP had been performed for severe sepsis and septic shock from 1994 to 2010. These patients were allocated into two groups: those who survived for at least 28 days after the start of PMX-DHP therapy (S group: 201 patients) and those who did not (NS group: 101 patients). Background factors (age, gender, APACHE II scores, sepsis-related organ failure assessment score, Goris multiple organ failure (MOF) score), hemodynamics (blood pressure, PaO2/FiO2 ratio, catecholamine requirement), inflammatory mediators (IL-6, IL-8, IL-1ra), endothelial-related markers (PAI-1, ELAM-1) and procalcitonin levels were examined in each group.


On background factors, only the Goris MOF score showed a statistically significant difference among the groups. Blood pressure and the PaO2/FIO2 ratio both improved markedly immediately after PMX-DHP. Also, the average required amount of catecholamine decreased after PMX-DHP. IL-6 and IL-1ra levels decreased immediately after PMX-DHP in both groups, but these values before PMX-DHP did not show any statistically significant difference between the groups. PAI-1 levels showed a significant decrease after PMX-DHP in both groups.


We confirmed an improvement in pulmonary oxygenation and hemodynamic parameters using PMX-DHP for severe sepsis and septic shock patients. The levels of various inflammatory mediators decreased using PMX-DHP, but we did not find any correlation between these changes and outcome.

Author information

Authors and Affiliations


Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Matsuo, S., Ikeda, T. & Ikeda, K. Re-evaluation of direct hemoperfusion with polymyxin-B immobilized fiber for severe sepsis and septic shock. Crit Care 15 (Suppl 1), P120 (2011).

Download citation

  • Published:

  • DOI:


  • Septic Shock
  • Severe Sepsis
  • Multiple Organ Failure
  • Procalcitonin
  • Septic Shock Patient