Abstract
We sought to evaluate the clinical implication of endotoxin levels in gram-negative bacilli (GNB)-induced abdominal septic shock patients with polymyxin B-hemoperfusion (PMX-HP) treatment. A prospective cohort of 60 patients who received surgical infectious source control for abdominal sepsis from January 2019 to December 2020 was included in the study. Endotoxin activity (EA) levels and Sequential Organ Failure Assessment (SOFA) scores were assessed immediately after surgery (baseline), 24, and 48 h post baseline. With receiver operating characteristic curves, the patients were stratified into two groups by the EA cut-off value (high-risk group vs low-risk group) and the clinical outcomes were compared. Logistic regression was performed to identify the clinical impact of PMX-HP on in-hospital death. Among the 31 high-risk patients (EA level ≥ 0.54), 16 patients (51.6%) received PMX-HP treatment and showed significant decreases in EA levels compared to patients who underwent conventional treatment only (− 0.34 vs − 0.12, p = 0.01). SOFA scores also showed significant improvement with PMX-HP treatment (12.8–8.9, p = 0.007). Fourteen in-hospital deaths occurred (45.2%), and PMX-HP treatment had a protective effect on in-hospital death (odds ratio (OR) 0.04, p = 0.03). In 29 low-risk patients (EA level < 0.54), seven patients (24.1%) received PMX-HP treatment and showed significant decreases in EA levels (0.46–0.16, p = 0.018). However, SOFA scores and in-hospital deaths were not improved by PMX-HP treatment. EA level significantly decreased after PMX-HP treatment and it may represent a therapeutic option to improve organ impairment and in-hospital death in septic shock patients with EA levels exceeding 0.54.
Highlights
Endotoxin, which is a major component of the outer membrane of gram-negative bacilli (GNB), would be a powerful causative agent of systemic inflammatory response syndrome by releasing various inflammatory cytokines[1,2,3,4,5,6]
The detection of high Endotoxin activity (EA) levels in septic patients may be used as a signal for initiating polymyxin B-hemoperfusion (PMX-HP), a direct endotoxin removal treatment, which is expected to resolve and prevent multi-organ failure induced by septic shock[1]
Our results showed that patients with abdominal sepsis or septic shock experienced significant improvements in EA levels and Sequential Organ Failure Assessment (SOFA) scores by receiving additional PMX-HP treatment after infection source-removing surgery
Summary
Endotoxin, which is a major component of the outer membrane of GNB, would be a powerful causative agent of systemic inflammatory response syndrome by releasing various inflammatory cytokines[1,2,3,4,5,6]. Endotoxin activity (EA) is regarded as a useful assessment tool in evaluating the treatment response to initial sepsis management or the detection of a newly developed infection. Changes in EA levels might be feasible to evaluate the effect of treatment and help to improve clinical outcomes by the early detection of new infectious complications. There have been only few reports on the relationship between changes in endotoxin levels after surgical infection control and the prognosis of patients with abdominal sepsis. In 2019, we conducted a comparative study of polymyxin B-hemoperfusion (PMX-HP), a hemoperfusion treatment that removes serum endotoxin, in patients with severe intra-abdominal infections compared to the control group without PMX-HP8. We investigated EA levels before and after PMX-HP and their relevance to the clinical prognosis of patients who received surgery due to abdominal sepsis. We sought to identify the appropriate target of EA in patients with abdominal sepsis who might benefit the most from PMX-HP after surgery
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