title: Endotoxin removal by direct hemoperfusion with an adsorbent column using polymyxin B-immobilized fiber ameliorates systemic circulatory disturbance in patients with septic shock.
abstract: Direct hemoperfusion (DHP) with an adsorbent column using polymyxin B-immobilized fiber (PMX-F) has been shown to improve the state of shock in patients with septic shock. However, no evidence has been presented for a direct link between endotoxin removal by DHP with PMX-F and improvement in septic shock. We retrospectively analyzed clinical profiles of 24 patients with septic shock (16 patients, gram-negative; 8 patients, non-gram-negative septic shock) who underwent DHP with PMX-F. Patients with gram-negative septic shock were characterized by hyperdynamic circulation. DHP with PMX-F reduced blood endotoxin concentrations and ameliorated shock, with an improvement in hyperdynamic circulation in patients with gram-negative septic shock. Mean arterial pressure also was elevated after therapy in patients with non-gram-negative septic shock, but systemic hemodynamics were unaffected. Regardless of the causative microorganism, patients with endotoxemia (blood endotoxin level > 10 pg/mL) showed hyperdynamic shock, and DHP with PMX-F reduced blood endotoxin levels and ameliorated hyperdynamic circulation, whereas patients without endotoxemia showed features of shock without hyperdynamic circulation, and DHP with PMX-F ameliorated shock without affecting cardiac performance. In patients with gram-negative septic shock, blood endotoxin concentration correlated positively with cardiac output and negatively with systemic vascular resistance before DHP therapy. Reduction in blood endotoxin concentration by DHP therapy positively correlated with the reduction in cardiac output. Our findings indicate that the improvement in hyperdynamic circulation was related directly to endotoxin removal by the PMX-F column, and endotoxin has an important role in the development of hyperdynamic circulation in patients with gram-negative septic shock.
authors.affiliation: Kidney Center, First Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Kitakyusyu, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Uriu
authors.forename: Akihiko
authors.initials: A
authors.lastname: Osajima
authors.forename: Kinya
authors.initials: K
authors.lastname: Hiroshige
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Keiji
authors.initials: K
authors.lastname: Aibara
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Inada
authors.forename: Kayoko
authors.initials: K
authors.lastname: Segawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Anai
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takagi
authors.forename: Aki
authors.initials: A
authors.lastname: Ito
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kamochi
authors.forename: Kazo
authors.initials: K
authors.lastname: Kaizu
mesh_terms: D000327:Adsorption; D016470:Bacteremia / Q000628:therapy; D004731:Endotoxins / Q000097:blood* / Q000493:pharmacokinetics; D016905:Gram-Negative Bacterial Infections / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000628:therapy; D006464:Hemoperfusion / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D011112:Polymyxin B / Q000378:metabolism*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000628:therapy*
chemical_list: D004731:Endotoxins; D011112:Polymyxin B