Treatment Of Sepsis Research Articles (Page 1)

Sepsis is life-threatening inflammatory disease, and its pathogenesis and prognostic factors remain unclear. In addition, the symptoms and signs of sepsis patients lack specificity, which makes the diagnosis, treatment and prognosis evaluation of sepsis extremely difficult. Recently, with the emergence and development of detection technologies, various sepsis-related biomarkers have emerged. Biomarkers could be considered as indicators of either infection or dysregulated host response or response to treatment and/or aid clinicians to prognosticate patient risk. Therefore, searching for reliable biomarkers and evaluating their role in sepsis is envisaged to aid clinical decision-making. This article reviews the advances in research on sepsis biomarkers and their application in the early prediction of organ dysfunction to improve our understanding of current sepsis biomarkers and provide a reference for the application of biomarkers in the clinical diagnosis, treatment, and prognosis of sepsis. Besides, we propose that the combining multiple biomarkers is expected to be a more accurate and comprehensive strategy to evaluate the condition and prognosis of sepsis patients.

Background: Optimizing early antimicrobial therapy and incorporating clinical pharmacists into sepsis treatment strategies are essential for improving patient outcomes. Objective: To examine the appropriateness of empiric antimicrobial selection for patients presenting with community onset sepsis with confirmed bacteremia, to characterize de-escalation practices, and to evaluate pharmacy involvement throughout the sepsis care process. Methods: We conducted a retrospective review of adult patients with community-onset sepsis and confirmed bacteremia who presented to the Emergency Department (ED) between 9/2022 and 5/2023 at our hospital. The primary outcome was the percent of patients with ineffective empiric antimicrobials. Secondary outcomes included time to de-escalation, sepsis outcomes, sepsis guidelines adherence, and pharmacy interventions. Results: 109 patients were included. Median Charlson Comorbidity Index (CCI) was 6 (IQR 3-8) and Pitt bacteremia score 0 (IQR 0-1). Median time to first antibiotic administration was 29 minutes (IQR 15-50). Ineffective empiric antimicrobials occurred in 13.7% of cases, with median time to effective antibiotics at 24h. De-escalation occurred in 84% of cases. The median time for discontinuation was 2days for antimicrobial coverage against MRSA and atypical organisms and 4days for coverage against P. aeruginosa. Initial therapy adhered to guidelines in 70.6% of cases, with deviation primarily due to vancomycin administration in the absence of MRSA risk factors. Antibiotic-related pharmacy recommendations were made in 40% (n = 44/109) of ED patients and 96% (n = 105/109) of hospitalized patients. In-hospital mortality, ICU admission, 30-day infection related re-admission and C. difficile infection within 6 months were 8.3% (n = 9), 42.2% (n = 46), 8.3% (n = 9), and 1.8% (n = 2), respectively. Conclusion: Pharmacist involvement led to appropriate antimicrobial selection in the ED, effective de-escalation, and favorable sepsis outcomes.

Early antibiotics are considered critical for bacterial sepsis treatment, although the benefit of this early timing may differ by the presence of shock. Little evidence exists from low- or middle-income settings. In patients referred from community hospitals to a tertiary center, we tested whether pre-referral antibiotic administration is associated with 28-day survival in sepsis, and whether this association differs by the presence of shock. Secondary analysis of a prospective cohort study that enrolled patients from 2013 to 2017 with a primary diagnosis of infection made by an attending physician and at least three Surviving Sepsis Campaign criteria for sepsis. Tertiary care hospital in northeastern Thailand. A total of 2593 adults with sepsis defined by primary diagnosis of infection and modified Sequential Organ Failure Assessment score greater than or equal to 2 who were referred from community hospitals. Antibiotics administered at the referring community hospital. The median age was 59 years (interquartile range 44-72), 2233 (86.1%) were transferred the same day as initial presentation, and 1897 (73.2%) received antibiotics prior to referral. Blood cultures grew bacteria in 313 (12.1%). Twenty-eight-day mortality was 18.9%. In the propensity score-matched cohort (n = 722 sepsis without shock, n = 244 septic shock), shock modified the association between pre-referral antibiotics and death (interaction p = 0.001). In patients with septic shock, pre-referral antibiotics were associated with lower hazard of death (hazard ratio [HR], 0.38; 95% CI, 0.19-0.75) but in patients without shock there was no association with hazard of death (HR, 1.36; 95% CI, 0.96-1.92). In rural Thailand, antibiotic administration prior to referral was associated with lower hazard of death in patients with septic shock. Our findings extend to a resource-limited setting evidence supporting the benefit of early antibiotic administration in septic patients with shock.

Sepsis is a life-threatening syndrome characterized by dysregulated host responses to infection, leading to severe organ dysfunction and a high mortality rate. Reducing the incidence of sepsis is of paramount importance. Given that sepsis-associated drugs largely fail in clinical trials, in this project, we devised and validated a novel long-acting C5a-blocking cyclic peptide drug (Cp1) via phage screening technology to block the upstream “bottleneck molecule” C5a-mediated amplification cascade of the inflammatory response. In the early stage of infection, we utilized the efficient neutralization of Cp1 against C5a to effectively curb the “waterfall effect” of inflammatory factors and mitigate the progression to dysregulated systemic inflammation, thereby providing effective prevention and therapeutic intervention for sepsis. First, in vitro and in vivo studies collectively demonstrated the optimal binding affinity and blocking selectivity of Cp1. The excellent plasma stability of Cp1 further endows it with antibody-like systemic circulation. In the CLP-induced sepsis model, Cp1 significantly suppressed the expression of inflammatory factors and chemokines in both plasma and peritoneal lavage fluid (PLF). Additionally, Cp1 potently inhibited innate immune injury. Ultimately, after a single administration of Cp1, the CLP-induced septic mice presented a significant reduction in bacterial burden, evident amelioration of organ dysfunction, and notable prolongation of survival time. Overall, the novel cyclic peptide drug Cp1 developed in this study is a highly promising and cost-competitive therapeutic option for sepsis prophylaxis and therapy.

Introduction: Sepsis, a leading cause of mortality and critical illness globally, is a life-threatening condition due to dysregulated host immune response to infection, which may lead to multiple organ dysfunction. We previously reported that depletion of PDE4B, ameliorated myocardial ischemia-reperfusion injury, revealing a pivotal role of PDE4B in sterile inflammation. This study aimed to elucidate the role of PDE4B in sepsis. Approaches: PDE4B global knock-out (PDE4B -/- ), endothelial cell-specific (PDE4B EC-/- ) and myeloid cell-specific (PDE4B LYZ-/- ) PDE4B knock-out male mice and their littermate controls were induced to develop sepsis following cecal ligation and puncture (CLP) surgery. Animal survival was recorded for 7 days after CLP. Early pathological changes were assessed at 12h-post CLP by determining vascular permeability, echocardiography, plasma level of markers for liver and kidney injury (ALT, AST, CREA and BUN). Microcirculation was detected by laser Doppler flowmetry. Histology staining was performed on lung sections and lipopolysaccharide transfected isolated lung endothelial cells were used to delineate the mechanism of pyroptosis. Results: Deletion of PDE4B significantly improved the survival rate of septic mice (73% versus 31%). Meanwhile, PDE4B deletion markedly reduced organ injury, including reduced lung vascular permeability and myeloid cell infiltration, improved function of heart (LVEF: 40.2±6.0% versus 75.2±5.0%), liver and kidney, and increased hindlimb blood perfusion (48.46±9.08 versus 90.41±5.86). Strikingly, deficiency of endothelial cell (but not myeloid cell)-PDE4B protected against sepsis to an extent similar to global PDE4B knock-out (survival rate: PDE4B EC-/- 70% versus PDE4B LYZ-/- 30%). Mechanismly, sepsis induced extensive pyroptosis in lung tissue and PDE4B deletion essentially abolished the activation of gasdermin-D, the key executor of pyroptosis. Further in vitro study showed that PDE4B played a critical role in endothelial cells pyroptosis, in both transcription dependent and in-dependent manner. Conclusions: Endothelial cell PDE4B promotes pyroptosis, critically involving in sepsis induced multiple organ dysfunction. Selective inhibition of PDE4B represent a promising approch to sepsis treatment.

BackgroundSepsis is a life-threatening condition characterized by organ dysfunction resulting from dysregulated host response to infections. Approximately 48.9 million people worldwide are diagnosed with sepsis annually, leading to 11 million deaths and representing 19.7% of all global deaths. No specific, effective treatments for sepsis, which has a poor prognosis, are available.ObjectiveThe study aimed to systematically explore the association between genetically predicted modifiable risk factors and sepsis.MethodsUnivariable 2-sample Mendelian randomization (MR) analysis was performed to explore the association between 30 modifiable risk factors (12 lifestyle, 3 educational and psychological, and 15 metabolic factors) and sepsis. Heterogeneity was evaluated using the Cochran Q analysis. Sensitivity analyses were conducted using the MR-Egger regression intercept tests and leave-one-out analyses. Additionally, multivariable MR analyses were performed to adjust for genetic associations between the instruments and obesity.ResultsGenetically predicted smoking (odds ratio [OR] 1.20, 95% CI 1.06‐1.36; P=.005), a higher number of cigarettes smoked daily (OR 1.70, 95% CI 1.29‐2.23; P<.001), a higher overall health rating (OR 2.19, 95% CI 1.61‐2.98; P<.001), BMI (OR 1.50, 95% CI 1.38‐1.63; P<.001), waist circumference (OR 1.70, 95% CI 1.53‐1.89; P<.001), whole body fat mass (OR 1.50, 95% CI 1.37‐1.64; P<.001), trunk fat mass (OR 1.48, 95% CI 1.36‐1.62; P<.001), arm fat mass (OR 1.57, 95% CI 1.43‐1.71; P<.001), and leg fat mass (OR 1.69, 95% CI 1.51‐1.90; P<.001) were associated with increased sepsis risk. However, light physical activity (OR 0.26, 95% CI 0.08‐0.83; P=.03), higher education attainment (OR 0.52, 95% CI 0.40‐0.67; P<.001), and high-density lipoprotein cholesterol (OR 0.91, 95% CI 0.84‐0.98; P=.02) exhibited protective effects against sepsis. Using a multivariate analysis of obesity traits, the waist circumference (OR 2.16, 95% CI 1.18‐3.96; P=.01) was an independent risk factor of sepsis.ConclusionsOur study demonstrated that genetic predictors of lifestyle (smoking and physical activity), educational level, and metabolic factors (waist circumference and high-density lipoprotein cholesterol) exhibited a causal association with sepsis risk. Future research should further investigate the underlying mechanisms of these associations to inform more effective preventive strategies against sepsis.

A combined metabolomics and biochemometrics approach for the rapid identification of antibacterial naphthyl derivatives from Guiera senegalensis leaves.

To determine the effect of hemoperfusion with a polymer-based column on systemic cytokine concentrations and neutrophil dysfunction in lipopolysaccharide-treated horses in vivo. 6 university-owned horses received 60 ng/kg lipopolysaccharide, IV, as a bolus and then 60 ng/kg, IV, as a constant rate infusion over 1 hour. Endotoxemia was confirmed by clinical signs and neutropenia. In a crossover model that was completed from January 2024 through July 2024, hemoperfusion was performed for 4 hours with either a sham or polymer column. Blood was collected at 5 time points over a 72-hour period for flow cytometry analysis and 14 time points for cytokine multiplex analysis. There were significant differences between column treatment and sham treatment, including increased early and late neutrophil apoptosis and improved reactive oxygen species production in response to stimulation at the postfiltration time point. Additionally, 2 of 5 column-treated horses had improved CBC parameters compared to 0 of 5 sham-treated horses. Systemic cytokines were not significantly different between column and sham treatment. The results of this study provide proof of concept for hemoperfusion with a polymer-based column as a potential treatment to mitigate deleterious lipopolysaccharide-induced immune responses in adult horses. Further investigation and optimization of hemoperfusion as an adjunctive treatment for sepsis in the horse is warranted. Because there are known differences in lipopolysaccharide infusion and clinical sepsis, further investigation in horses with clinical sepsis is needed.

Burden of carbapenem-resistant Gram-negative bacterial infections in Vietnam: a national hospital survey.

Praeruptorin A (PA), a monomer derived from the traditional Chinese medicine Peucedani Radix, is known for its therapeutic properties, including heat clearance, phlegm dissolution, and asthma relief. Sepsis, characterized as a systemic inflammatory response syndrome (SIRS), is triggered by a cytokine storm resulting from pathogenic infection and can progress to multi-organ failure. This study investigates and predicts the effective molecular targets and potential mechanisms of PA in the context of sepsis through the application of network pharmacology. The identified targets were subsequently validated using an invitro molecular model, thereby providing a robust theoretical basis for our findings. Our results indicate that PA significantly reduced malondialdehyde (MDA) accumulation, ameliorated glutathione (GSH) depletion, enhanced glutathione peroxidase 4 (GPX4) expression, and restored mitochondrial function. Notably, PA markedly decreased prostaglandin-endoperoxide synthase 2 (PTGS2) expression, which collectively suggests that PA may inhibit ferroptosis. We propose that PA may exert its inhibitory effects on ferroptosis in macrophages via modulation of PTGS2, highlighting its potential as a drug for sepsis treatment.

Sepsis and septic shock.

Dual-channel batch constrained deep Q-learning for sepsis treatment

This study aimed to measure the association of race and ethnicity, preferred language, income, and insurance status on process and outcomes measures of sepsis care in a pediatric emergency department (PED). A single-center, retrospective cohort study was conducted at the only tertiary-care children's urban hospital with a PED in New Mexico. Children aged 2 months to younger than 18 years old who were evaluated in the PED from July 2020 to July 2023 and met sepsis criteria by ICD-10 codes were screened for inclusion. Demographic data and outcomes including median time to fluid bolus, time to antibiotics, PED length of stay (LOS), and hospital LOS were collected from the electronic medical records. There was no significant difference in time to sepsis interventions by demographic factors studied. Patients who reported preferring a language other than English had longer PED LOS (350 min, P = 0.024) compared with English speakers (245 min), but there were no other significant differences in PED and hospital LOS by demographic factors. There were no associations between race and ethnicity, income, preferred language, insurance status, and time to sepsis interventions. PED LOS was significantly different by reported preferred language. This overall lack of differences may be attributed to the local context of the study, which may not be generalizable to other areas. Further research is warranted to investigate processes that lead to similar care and barriers to timely interventions.

The update of the S3guidelines "Sepsis-Prevention, diagnosis, treatment and follow-up care" was published on 25July 2025. The new guidelines address 29new and 16revised recommendations, with 43recommendations remaining unchanged from the previous version. The 2025 update is atargeted adaptation of the internationally recognized recommendations of the Surviving Sepsis Campaign from 2021. The focus is on early individualized and evidence-based treatment, the integration of structured follow-up care after hospital discharge and astronger focus on patient-centered comprehensive care beyond acute treatment. Despite advances in early detection, antibiotic treatment and intensive medical care of patients, sepsis and septic shock remain potentially life-threatening conditions, underlining the necessity for early diagnosis and the initiation of appropriate treatment.

BackgroundIrisin, a novel myokine, has garnered significant attention for its roles in metabolic regulation and anti-inflammatory responses. Sepsis disrupts the intestinal microenvironment, exacerbating its progression and highlighting the need for novel therapeutic approaches. This study aims to investigate whether irisin exerts protective effects against lipopolysaccharide (LPS)-induced intestinal injury in septic conditions and to explore the underlying mechanisms involving the gut microbiota.MethodsTo induce sepsis, C57BL/6 mice were injected intraperitoneally with LPS at a dose of 10 mg/kg, and then administered with 1 µg/kg of irisin. The Activity levels and 7-day survival rate were recorded. The intestinal expression of irisin/FNDC5 was assessed using Western blotting and immunofluorescence staining. Inflammatory factors were measured using enzyme-linked immunosorbent assay (ELISA). Peripheral blood bacteria were cultured on blood agar plates. Intestinal histomorphology was analyzed via hematoxylin and eosin (H&E) staining. The expression of occludin and apoptotic-related proteins was determined by Western blot, and apoptotic cells were detected using the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) method. The intestinal microbiota was analyzed through 16S rRNA amplicon sequencing.ResultsIrisin improved the survival state and rate of LPS-induced septic mice. It restored endogenous irisin/FNDC5 levels in intestinal tissues, mitigated intestinal barrier injury, and alleviated bacteremia following sepsis treatment. Furthermore, irisin exhibited anti-inflammatory properties by increasing the levels of IL-22 while decreasing those of TNF-α and IL-6, as well as anti-apoptotic effects by increasing levels of pro-caspase-3 and Bcl-2 while decreasing cleaved caspase-3, Bax, and the positive density of apoptotic cells. Additionally, it regulated intestinal microbiota dysfunction.ConclusionIrisin effectively treats septic acute intestinal injury by reducing apoptosis and inflammation, with the intestinal microbiota likely playing a crucial role. This finding offers a novel approach to clinical management of sepsis.

Optimal antibiotic treatment is important in the treatment of sepsis. However, patients with sepsis are at risk of suboptimal antibiotic concentrations. This study aimed to evaluate β-lactam antibiotic concentrations during the first 48 h in patients with community-acquired sepsis admitted to the ICU, and to identify variables associated with antibiotic concentrations that were too low or too high. This prospective, observational, single-centre study included patients aged ≥18 years with a high likelihood of infection, a SOFA score of ≥2p, planned β-lactam antibiotic treatment, and ICU admission. The exclusion criteria were ongoing antibiotic treatment and/or nosocomial infections. β-Lactam concentrations were measured up to seven times during the first 48 h. The estimated trough concentrations were divided by the predetermined MIC to generate MIC-multiples for comparison. Patients were allocated to three groups based on the MIC-multiple (MIC× < 1, 1-8 or >8). Fifty patients were included, with a median of seven samples per patient (257 samples). The group with MIC-multiples of <1 (n = 16) was associated with younger age, lower Charlson comorbidity index, Simplified Acute Physiology Score 3, creatinine concentration, and need for noradrenaline. The group with MIC-multiples of >8 (n = 15) had higher creatinine and noradrenaline levels. ICU patients with sepsis are at risk of either too low or too high antibiotic concentrations, and specific patient characteristics may be predictable. Therapeutic drug monitoring in combination with model-informed precision dosing may also help to optimize antibiotic dosing in the early phase of community-acquired sepsis to prevent treatment failure and toxicity.

Children of Pacific ethnicity living in Aotearoa New Zealand have the second highest incidence of bone and joint infections (BJI) globally. This paper reports illness characteristics and outcomes for Pacific children diagnosed with acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) from the Auckland Region over a 5-year period. It also reports features associated with severe and complex disease. Cases included all children aged ≤15 years hospitalised for AHO or SA in the Auckland Region, 1 January 2018-31 September 2023. Prioritised ethnicity was identified from hospital records. Direct medical hospitalisation costs, treatment type and outcomes were described up to 1 year following discharge. Complex illness was defined as recurrence/chronic infection, readmission, intensive care admission, complication following treatment or >1 surgical procedure. Of 563 cases of acute BJI, 152 were children identifying as Pacific ethnicity. Compared with NZ European children with BJI, Pacific children had more eczema (34% vs 19%, p=0.002), multifocal sepsis (30% vs 10%, p=<0.05) and surgical intervention (61% vs 47%, p=0.01) with lengthier hospitalisations (14 days vs 9 days, p=0.001). Most Pacific children experienced complex illness (66%). Complex illness was associated with cultures positive for Staphylococcus aureus and eczema diagnosis. In regression analysis, complex illness was less likely for children with a previous throat swab positive for group A Streptococcus (GAS). Pacific children with BJI experience more severe illness compared with NZ European children with BJI. Eczema is common among Pacific children with BJI. Proactive eczema management may represent suitable focus for disease prevention. Prior GAS throat swab appears associated with reduced rates of complex illness.

Sepsis is a life-threatening condition that occurs when infection drives an overwhelming immune response that damages tissues and results in multi-organ dysfunction. Current treatment of sepsis focuses on eliminating the infectious pathogen and supporting the cardiovascular system. However, effective therapeutics for mitigating the dysregulated immune response in sepsis are still lacking. To this end, many sepsis survivors end up with immunoparalysis and an increased risk of recurring infections. Despite the growing body of research revealing the close interplay between the nervous and immune systems, modulating the neuroimmune pathways remains an unexplored route of treatment. The sympathetic arm of the autonomic nervous system, particularly β-adrenergic receptor signalling, is integral in limiting the inflammatory response during bacterial infections. However, our current understanding of the neuroimmune interactions and their impact on sepsis pathophysiology remains limited. In this review, we outline current insights into the neuroimmune response in sepsis, with a particular focus on the role of the sympathetic nervous system in modulating immune responses against bacterial infections. Elucidating the neural signalling pathways that regulate the immune response and recovery in sepsis will reveal new therapeutic targets to reduce disease burden and improve patient outcomes.

Abstract Background and Aims Endotoxin, also referred to as lipopolysaccharide (LPS), is a major stimulus of the inflammatory response capable of leading to sepsis and septic shock. Extracorporeal blood purification therapies are increasingly employed in the treatment of sepsis. Timely and thorough removal of endotoxin and cytokines can help to mitigate the inflammatory cascade during septic shock. Hemoadsorption (HA) is a promising approach to achieve this goal. In this study, we analyzed different prototypes of a new CA cartridge: we performed in vitro circulations to define endotoxin and cytokines removal capacity. Method In vitro HA was performed using GALILEO testing platform, customized circuits with 5 mini-modules (XCA 1–5, shown in Fig. 1) containing the new CA sorbent material (Jafron Biomedical, Zhuhai, People's Republic of China) with slightly different chemical composition were prepared. A batch of 500 mL of blood pre-conditioned with LPS was utilized for each circulation. Circulation was maintained for 2 hours at a blood flow rate (QB) of 100 mL/min in a closed-loop configuration (Fig. 2). Samples (3 mL each) were taken from the experimental batch at 0, 10, 30, 60 and 120 minutes. Endotoxin activity and removal ratio (RR) of LPS, Interleukin 6 (IL-6) and Interleukin-1 beta (IL-1β) were assessed. Results The prototypes showed different performances, highlighting promising adsorption affinity towards the target molecules. Endotoxin activity values showed a significant decrease over the course of the five experiments, with an initial mean value of 3.2 ± 1.2 and a final mean value of 0.7 ± 0.2 (Fig. 3); XCA 2 and XCA 4 displayed the major reduction, 83.3% and 81.1%, respectively. All the concentrations and RRs are reported (Fig. 4). The highest LPS reductions were observed with XCA 1 and XCA 5, at the end of the experiments we found a RR of 13.2% and 13.3%, respectively (Fig. 5). Cytokine concentration over time in the five experiments showed different trends. XCA 3 obtained IL-6 RR of 80.9%; XCA 5, whereas, removed 28.2%; XCA 1, XCA 2 and XCA 4 didn't exhibit a remarkable IL-6 reduction (Fig. 6). XCA 2 displayed a relevant reduction of IL-1β concentration, we observed a RR of 61.2% after 120 minutes of circulation. XCA 1 and XCA 3 removed about 20% of IL-1β, XCA 4 and XCA 5 didn't exhibit a consistent IL-1β reduction (Fig. 7). Conclusion Our experiments allowed to characterize the prototypes in terms of adsorption capacity for both endotoxin and cytokines. Our findings represent the first evaluation of endotoxin adsorption within an in vitro blood hemoadsorption model employing the prototypes of CA cartridge. The reduction in the endotoxin activity values over time and the LPS and cytokines RRs provide useful signals indicating CA potential application in the early phases of the sepsis cascade with the possibility to target removal of endotoxin and the subsequent humoral effectors of the cascade.

Abstract Background and Aims Sepsis is one of the major causes of hospital mortality, characterized by a dysregulated immune response to infection that can lead to multiorgan failure and death. Gram-negative bacteria have emerged as primary contributors to sepsis and septic shock. Patients with sepsis induced by Gram-negative bacteria exhibit high endotoxin activity. Endotoxin, or lipopolysaccharide (LPS), is a component of the Gram-negative bacterial membrane and a potent stimulator of the inflammatory cascade. Therefore, effective strategies for LPS removal are crucial in sepsis treatment. Extracorporeal blood purification therapies, particularly hemoadsorption, have been extensively studied for their potential to modulate the immune response in septic patients. This in vitro study aimed to assess the endotoxin and cytokines removal capacity of two new cartridges. Method We studied a downscaled module of the CA and pHA cartridges (Jafron Biomedical, Zhuhai City, China) in an in vitro closed-loop hemoadsorption configuration (Fig. 1). The characteristics of the two cartridges are summarized in Fig. 2. A total of 1,300 mL of blood were inoculated with 25 mg of LPS, and each cartridge was perfused with a batch of 500 mL of blood. Two additional batches of 150 mL of blood was maintained as negative (CTR−) and positive control (CTR+). Blood was maintained at 37° and continuously stirred throughout the experiment. Circulation was performed using the GALILEO testing platform with a blood flow rate of 100 mL/min and lasted 2 hours. Solution samples were collected from the experimental batches at different time-points. Adsorption capacity towards endotoxin and inflammation factors was assessed by measuring Endotoxin Activity Assay (EAA) and the Removal Ratio (RR) of LPS, Interleukin-6 (IL-6) and Interleukin-1β (IL-1β). Results The cartridges exhibited distinct trends in removing target molecules, both effectively adsorbed endotoxin and cytokines. EAA values showed a significant decay over time: pHA and CA achieved a notable reduction of endotoxin activity, reduced by 51.2% and 65.9%, respectively (Fig. 3). CA cartridge showed a progressive and constant decrease in LPS concentration, whereas the pHA displayed a more variable pattern (Fig. 4), both cartridges achieved a similar LPS concentration, with LPS removal of about 30% at the end of the experiments. Promising results of CA cartridge were confirmed by its cytokines removal capacity. IL-6 concentration decreased exponentially with CA, reaching a RR of 49.2% within 10 minutes and 83.9% at 120 minutes. pHA instead, showed a more gradual reduction, reaching a RR of 43.5% at the end of the experiment (Fig. 5). Similarly, IL-1β decreased exponentially with CA, reaching very low levels within 30 minutes of circulation. RR obtained with pHA followed a linear trend, reaching a value of 63.9% at the end of the experiment, compared to 92.6% with CA (Fig. 6). Conclusion The reduction in endotoxin activity and concentration of LPS and cytokines represents an initial evidence of the efficacy of the two cartridges examined. This study demonstrated that both cartridges, CA and pHA, are capable of adsorbing endotoxin as well as pro-inflammatory and anti-inflammatory cytokines. These results provide a foundation for further studies aimed at more comprehensive characterization of these devices. In particular, their application in vivo will be essential to confirm the immunomodulation capacity in septic patients.