Clinical Effects of Endotoxin Adsorption Therapy for Patients with Septic Multiple Organ Failure

Abstract

  In 94 septic multiple-organ-failure patients who were treated with endotoxin adsorption therapy (PMX-DHP) , changes in circulatory parameters (SAP, MAP, SVR) , pulmonary oxygenation (PaO₂/FiO₂) , various cytokine levels (TNF-α, IL-6, IL-8, IL-1ra, and IL-10) and endothelial cell relating markers (ICAM-1, ELAM-1, PAI-1, thrombomodulin) were examined separately according to the patient outcome (45 survivors and 49 non-survivors) . Also, background factors and procalcitonin were examined in each group. Time of shock onset to PMX-DHP was not significantly different between the two groups. A circulatory system was improved in both groups, and PaO₂/FiO₂ was improved significantly in the survival group. TNF-α, IL-6, and IL-8 did not change in PMX-DHP. IL-10 and IL-1 receptor antagonist (IL-1ra) tended to be higher in the non-survival group than the survival group. In addition, IL-1ra decreased in both groups significantly after PMX -DHP completion, and ELAM-1 and PAI-1 decreased in the survival group after PMX-DHP completion. Procalcitonin in the survival group showed a significant decrease from 87±136ng/mL to 67±106ng/mL (P< 0.05) . On the other hand, PCT in the non-survival group increased from 44±106ng/mL to 49±72ng/mL. These results suggested that we should consider the timing of endotoxin adsorption therapy and the severity of the septic multiple organ failure in the patients.