Abstract

Involvement of the activation of neutrophils and vascular endothelial cells in the pathology of sepsis has recently been reported. We therefore investigated whether direct hemoperfusion (DHP) with a polymyxin B immobilized fiber column (PMX) could reduce the level of plasminogen activator inhibitor-1 (PAI-1), an index of vascular endothelial cell activation. Twelve sepsis patients satisfying the following criteria were enrolled in the study: (i) stable global oxygen metabolism (oxygen delivery index>500 mL/min/m2 and oxygen consumption index>120 mL/min/m2); (ii) abnormal tissue oxygen metabolism (PCO2 gap: gastric mucosal PCO2 minus arterial PCO2 difference>8 mm Hg); and (iii) mean blood pressure>or=60 mm Hg. Direct hemoperfusion with PMX was performed twice (for 3 h each time) within 24 h. Plasminogen activator inhibitor-1 was measured a total of 5 times: before PMX-DHP, immediately after the first DHP with PMX session (3 h after the start), and 24, 48, and 72 h afterward. The PAI-1 value was 150+/-30.0 ng/mL before DHP with PMX, 178+/-60.0 ng/mL immediately after DHP with PMX, 90+/-22.1 ng/mL at 24 h after, 65+/-21.0 ng/mL at 48 h after, and 64+/-18.3 ng/mL 72 h after. The values were significantly lower from 48 h onward compared with baseline. These data suggest that DHP with PMX inhibits vascular endothelial cell activation.

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