Effect of direct hemoperfusion using polymyxin B immobilized fiber on inflammatory mediators in patients with severe sepsis and septic shock

Abstract

The objective of this study was to investigate retrospectively the effect of direct hemoperfusion using polymyxin B immobilized fiber (PMX-DHP) in a cartridge to remove endotoxin on inflammatory mediators in septic patients. PMX-DHP was performed 59 times in 40 patients with severe sepsis and septic shock due to gram-negative bacterial infection. Mean age and APACHE II score were 63 years and 22, respectively. The first treatments with PMX-DHP were started when patient hemodynamics were unstable even after conventional therapies. The second treatments were performed in 19 patients whose hemodynamics were still unstable after the first PMX-DHP. The changes in inflammatory mediator levels were compared from baseline to post treatment with PMX-DHP. Statistical differences were calculated using the Wilcoxon rank sum test. Plasma endotoxin could be detected in 34 patients, which was significantly decreased in 20 cases measured by a chromogenic kinetic limulus amebocyte lysate assay (p=0.0254) and in 14 cases measured by a new limulus turbidimetric time assay (p=0.0196). Monocyte counts in peripheral blood decreased significantly (p=0.0402). Interleukin-6 decreased significantly (p=0.0020). Blood pyruvate also decreased significantly (p=0.0025). At the same time, mean arterial pressure, pulse pressure, systemic vascular resistance index, and urine output were significantly increased. These results indicated that PMX-DHP could decrease inflammatory mediators and be effective to interrupt the pathogenic sequence leading to septic shock due to gram-negative bacterial infection.