Endotoxin Elimination in Patients with Septic Shock: An Observation Study.

Barbara Adamik,Jakub Smiechowicz,Andrzej Kübler,Stanislaw Zielinski

doi:10.1007/s00005-015-0348-8

Barbara Adamik, Jakub Smiechowicz + Show 2 more

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https://doi.org/10.1007/s00005-015-0348-8

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Abstract

To evaluate the effectiveness of endotoxin elimination with an adsorption column in patients with septic shock and endotoxemia. The elimination therapy was guided by a new bedside method of measuring endotoxin activity (EA). Intensive care unit (ICU) patients with septic shock and suspected Gram-negative infection were consecutively added to the study group within the first 24 h. Endotoxin elimination was performed using hemoperfusion with the Alteco LPS Adsorber. The primary endpoint was improvement in organ function within the first 24 h of treatment. A secondary objective was to assess the usefulness of a new method of measuring EA to help guide endotoxin elimination therapy. Out of 64 patients 18 had a high baseline EA [0.70 EA units (0.66–0.77)]. Those patients had endotoxin elimination treatment in addition to conventional medical therapy. At 24 h after endotoxin elimination, the EA had decreased to 0.56 EA units (0.43–0.77), (p = 0.005); MAP increased from 69 (62–80) to 80 mm Hg (68–88), (p = 0.002), and noradrenaline use decreased from 0.28 (0.15–0.80) to 0.1 μg/kg/min (0.00–0.70) at the same time (p = 0.04). The SOFA score had decreased from 11 (9–15) to 9 (7–14) points 24 h after endotoxin elimination (p = 0.01) with a median delta SOFA –2 points. Endotoxin elimination did not have a significant effect on the ICU length of stay or ICU mortality. Effective endotoxin elimination resulted in a significant improvement in hemodynamic parameters and of organ function. The application of the EA assay was useful for the bedside monitoring of endotoxemia in critically ill ICU patients.

Highlights

Lipopolysaccharide (LPS) is a component of the outer membrane of Gram-negative bacteria and a well-known endotoxin which induces an inflammatory response (Marshall et al 2004; Munford 2005; Murch et al 2007)
Sixty-four patients diagnosed with septic shock were treated in the Intensive care unit (ICU) from February to December 2011
At 24 h after the first session of endotoxin elimination, the value of endotoxin activity (EA) decreased to 0.56 EA units (EAU) (0.43–0.77), (p = 0.005)

Summary

Introduction

Lipopolysaccharide (LPS) is a component of the outer membrane of Gram-negative bacteria and a well-known endotoxin which induces an inflammatory response (Marshall et al 2004; Munford 2005; Murch et al 2007). It is released during proliferation or lysis of bacterial cells. Gram-negative pathogens from the primary site of infection are the source of endotoxins in septic shock Another cause of endotoxemia can be the transmucosal passage of either Gram-negative bacteria or just the LPS crossing from the intestines to sterile tissues. A high level of endotoxins is correlated with the degree of the cardiovascular failure (Monti et al 2010; Murch et al 2007), and with the acute physiology and chronic health evaluation (APACHE) II

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