title: Hemoperfusion with polymyxin B-immobilized fiber attenuates the increased plasma levels of thrombomodulin and von Willebrand factor from patients with septic shock.
abstract: OBJECTIVE
  The present study assessed whether plasma levels of thrombomodulin and von Willebrand factor (vWF) are altered in patients with septic shock and whether treatment with polymyxin B-immobilized fiber (PMX-F) affects these levels.
  
  
  METHODS
  Twenty-four patients with septic shock and 20 normal healthy controls were included in this study. Plasma levels of thrombomodulin and vWF were measured by enzyme immunoassay (EIA). The treatments with direct hemoperfusion using PMX-F column on patients with septic shock were repeated twice for 2 h each. Healthy controls were not subjected to hemoperfusion.
  
  
  RESULTS
  13 of 24 patients with septic shock survived (survival rate was 54.2%). Levels of blood endotoxin decreased significantly from 41.2 +/- 4.8 pg/ml at baseline to 13.2 +/- 3.6 pg/ml after direct hemoperfusion. Systolic blood pressure increased significantly from 82 +/- 6 mm Hg at baseline to 118 +/- 12 mm Hg after treatment. The patients with septic shock demonstrated significantly increased plasma levels of thrombomodulin (p < 0.001) and vWF (p < 0.001) compared with those in healthy controls. These increased levels of plasma thrombomodulin and vWF in patients with septic shock decreased significantly after treatment with PMX-F (p < 0.01).
  
  
  CONCLUSIONS
  These data suggest that plasma thrombomodulin and vWF may be related to septic shock and that PMX-F is effective in reducing these factors in patients with septic shock.
authors.affiliation: Nephrology Unit, Misato Junshin Hospital, Saitama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.forename: Y
authors.initials: Y
authors.lastname: Suzuki
authors.forename: N
authors.initials: N
authors.lastname: Shimada
authors.forename: I
authors.initials: I
authors.lastname: Ebihara
authors.forename: H
authors.initials: H
authors.lastname: Shoji
authors.forename: H
authors.initials: H
authors.lastname: Koide
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006464:Hemoperfusion / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B; D012772:Shock, Septic / Q000097:blood / Q000628:therapy*; D018180:Thrombomodulin / Q000097:blood*; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D004731:Endotoxins; D018180:Thrombomodulin; D014841:von Willebrand Factor; D011112:Polymyxin B