- 1 L. G. Sokolov Memorial Hospital № 122, St. Petersburg, Russia
- 2 St. Elisabeth Municipal Hospital, St. Petersburg, Russia
- 3 POCARD Ltd, Moscow, Russia
- 4 I. I. Mechnikov Northern-Western Medical University, St. Petersburg, Russia
Endotoxicosis is one of the main factors of the pathogenesis of multiple organic dysfunctions in gram-negative sepsis, induced by the accumulation of lipopolysaccharides - wall components of gram-negative bacteria. In vitro removal of them (LPS-adsorption) promotes better treatment outcomes in sepsis patients. Development and introduction of the Russian tools for LPS-adsorption becomes more crucial.
Objective: to evaluate the efficiency and safety of the column of Toxipak for endotoxin removal, manufactured by POCARD Ltd.
Materials and methods: 7 adult sepsis patients who had LPS-adsorption were included into the study. The changes of the following parameters were monitored in the patients: temperature, pulse, arterial pressure, respiration rate, central venous pressure, oxygen saturation, hourly rate of diuresis, oxygenation index was calculated, hematologic and biochemical blood parameters were tested as well as coagulation system rates, endotoxin level, C-reactive protein (CRP), procalcitonin, and interleukins (IL) 1, 6, 8. Criteria of the system inflammatory response and SOFA score were used for the comprehensive evaluation of clinical status. The adverse events, duration of stay in the intensive care ward and 18- and 24-day mortality were followed up during manipulations.
Results: the studied column provided no negative effect on the cellular and biochemical composition, main parameters of clotting system and acid-base balance of blood. Its use resulted in the reduction of endotoxin (LPS) (by 64%), CRP (by 14%), IL-1 (by 38%) in blood, increase of oxygenation index, and renal function improvement. LPS adsorption promoted the reduction of clinical and laboratory signs of system inflammatory response, and severity of organ dysfunction (from 6.0 to 3.0 as per SOFA score) in patients with sepsis and septic shock.
Conclusion: Toxipak column is safe and efficient for removal of endotoxins from blood.
Key Words: sepsis, septic shock, lipopolysaccharides, endotoxins, adsorption
- 1.Cohen J. The immunopathogenesis of sepsis. Nature, 2002, vol. 420, pp. 885-891.
- 2.Cruz D.N., Antonelli M., Fumagalli R. et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA, 2009, vol. 301, pp. 2445-2452.
- 3.Cruz D.N., Perazella M.A., Bellomo R. et al. Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Crit. Care, 2007, vol. 11, pp. 1-12.
- 4.Engel C., Brunkhorst F.M., Bone H.G. et al. Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intens. Care Med., 2007, vol. 33, no. 4, pp. 606-618.
- 5.Esteban E., Ferrer R., Alsina L., Artigas A. Immunomodulation in Sepsis: The Role of Endotoxin Removal by Polymyxin B-Immobilized Cartridge. Mediat. Inflammation, 2013, Article ID 507539, 12 p.
- 6.Kushi H. et al. Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation. Crit. Care, 2005, vol. 9, pp. 653-661.
- 7.Marshall J.C., Foster D., Vincent J.L. et al. Diagnostic and prognostic implications of endotoxemia in critical illness: results of the MEDIC study. J. Infect. Dis., 2004, vol. 190, pp. 527-534.
- 8.Martin G.S., Mannino D.M., Eaton S., Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. New Engl. J. Med., 2003, vol. 348, pp. 1546-1554.
- 9.Sato T., Shoji H., Koga N. Endotoxin adsorption by polymyxin B immobilized fiber column in patients with systemic inflammatory response syndrome: the Japanese experience. Ther. Apher. Dial., 2003, vol. 7, no. 2, pp. 252-258.
- 10.Shimizu T., Hanasawa K., Sato K. et al. The clinical significance of serum procalcitonin levels following direct hemoperfusion with polymyxin B-immobilized fiber column in septic patients with colorectal perforation. Eur. Surg. Res., 2009, vol. 42, pp. 109-117.
- 11.Shoji H. Extracorporeal endotoxin removal for the treatment of sepsis: endotoxin adsorption cartridge (Toraymyxin). Ther. Apher. Dial., 2003, vol. 7, no. 1, pp. 108-114.
- 12.Stewart I., Schluter P.J., Shaw G.R. Cyanobacterial lipopolysaccharides and human health – a review. Environ Health., 2006, vol. 5, no. 7, pp. 1-23.
- 13.Tani T., Hanasawa K., Endo Y. et al. Therapeutic Apheresis for Septic Patients with Organ Disfunction: Hemoperfusion using a Polymyxin B Immobilized Column. Artif. Org., 1998, vol. 22, no. 12, pp. 1038-1044.
- 14.Tani T., Shoji H., Guadagni G., Parego A. Extracorporeal Removal of Endotoxin: The Polymyxin B-Immobilized Fiber Cartridge. Ronco C., Piccinni P., Rosner M.H. (eds) Endotoxemia and Endotoxin Shock: Disease, Diagnosis and Therapy. Contin. Nephrol. Basel, Karger, 2010, vol. 167, pp. 35.
- 15.Tani T., Shoji H., Guadagni G., Parego A. Extracorporeal Removal of Endotoxin: The Polymyxin B-Immobilized Fiber Cartridge. Ronco C., Piccinni P., Rosner M.H. (eds) Endotoxemia and Endotoxin Shock: Disease, Diagnosis and Therapy. Contin. Nephrol. Basel, Karger, 2010, vol. 167, pp. 129.
- 16.Vincent J.L., Sakr Y., Sprung C.L. et al. Sepsis Occurrence in Acutely Ill Patients Investigators. Sepsis in European intensive care units: results of the SOAP study. Crit. Care Med., 2006, vol. 34, no. 2, pp. 344-353.
- 17.Zhou F., Peng Z., Murugan R., Kellum J. A. Blood purification and mortality in sepsis: a meta-analysis of randomized trials. Crit. Care Med., 2013, vol. 41, pp. 2209-2220.