2018 Volume 38 Issue 4 Pages 649-655
Lower intestinal perforation and ischemia frequently cause sepsis and organ dysfunction with disseminated intravascular coagulation (DIC), and may subsequently result in death. We have performed direct hemoperfusion with polymyxin B-immobilized fiber and continuous hemodiafiltration with polymethyl methacrylate （PMMA） to counteract severe sepsis. In December 2014, we introduced continuous hemodiafiltration with AN69ST (AN69ST-CHDF) as a cytokine-adsorbing hemofilter. Seventy-three cases of lower intestinal perforation and ischemia since January 2010 until January 2018 were classified into 35 cases in the earlier period (before using AN69ST), 38 cases in the later period (after using AN69ST), and all cases were allocated to one of three subgroups: : group A (saved), group B (died after 28 days in hospital) and group C (died within 28 days), with estimation of the severity of sepsis using the APACHE Ⅱ and SOFA scores and the JAAM DIC diagnostic criteria. The survival rate of the earlier period was 49%, whereas the rate improved in the later period to 68%. Interestingly, in group A, the rate of DIC was 1.5-fold higher in the later period (46%) than in the earlier period. AN69ST-CHDF has been indicated in 12 cases, 9 of whom have survived. Our data suggest that the improvement of the survival rate in the later period could be associated with combination therapy against septic DIC using recombinant thrombomodulin and AN69ST-CHDF.
