Changes of cytokines in direct endotoxin adsorption treatment on postoperative multiple organ failure.
Multiple organ failure (MOF) is a serious condition that involves simultaneous or consecutive functional failure of several important organs. Furthermore, sepsis is known to play an important role in the occurrence of MOF. Hemoadsorption therapy with the endotoxin adsorption column containing polymyxin B immobilized fibers by direct hemoperfusion (PMX-DHP) is reportedly effective in the treatment of septic shock. This study examined the changes induced on cytokines upon PMX-DHP treatment in 25 patients who underwent emergency abdominal surgery and were immediately started on a postoperative regimen of continuous hemodiafiltration (CHDF) and PMX-DHP. Postoperative MOF was observed in these patients with a mean APACHE II SCORE of 25.5. Eighty percent of patients survived for more than 1 month. We were able to reduce the necessary dose of dopamine in 85.7% of patients because hemodynamic stability improved after administration of PMX-DHP. Interleukin 6 blood levels did not change significantly before or after PMX-DHP treatment in either the surviving or nonsurviving patients. Blood interleukin 1 receptor antagonist levels decreased in both groups. Intercellular adhesion molecular-1, NOx, and thrombomodulin did not change significantly during the course of treatment in either group. Decreased blood levels of PAI-1 levels were found in the surviving patients whereas increased levels of PAI-1 were found in the non-surviving patients. In conclusion, PMX-DHP treatment may be limited clinically in its ability to remove inflammatory cytokines and humoral mediators. However, PMX-DHP treatment is useful for hemodynamic stabilization, which prevents development of MOF.
Fifth Department of Surgery, Hachioji Medical Center, Tokyo Medical University, Hachioji-City, Japan.
N
N
Matsuno
T
T
Ikeda
K
K
Ikeda
K
K
Hama
H
H
Iwamoto
M
M
Uchiyama
K
K
Kozaki
Y
Y
Narumi
K
K
Kikuchi
H
H
Degawa
T
T
Nagao
D018806:APACHE; D000327:Adsorption; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016207:Cytokines / Q000097:blood / Q000302:isolation & purification*; D004731:Endotoxins / Q000097:blood*; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000628:therapy*; D011113:Polymyxins / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000628:therapy*; D018805:Sepsis / Q000097:blood / Q000628:therapy; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D016207:Cytokines; D004731:Endotoxins; D011113:Polymyxins