Extracorporeal plasma treatment for the removal of endotoxin in patients with sepsis: clinical results of a pilot study.
Despite the advances in therapeutic approaches in the management of inflammatory conditions, the incidence of sepsis is on increase in the intensive care units (ICU). In a pilot study, we investigated whether the use of an apheresis system based on DEAE-cellulose is capable of reducing the plasma concentration of endotoxin in patients with severe sepsis. We enrolled 15 intensive care patients with severe sepsis and plasma endotoxin concentrations >0.3 EU/mL. In addition to standard ICU therapy, a total of 83 apheresis treatments were performed. About 1.7 volumes of plasma (6000 mL) were treated at each apheresis session. A significant reduction in plasma endotoxin levels from a median of 0.61 to 0.39 EU/mL (-35%) could be achieved (P < 0.001). Long-term comparison of the initial and post-treatment levels after a series of five to six individual apheresis treatments also showed a statistically significant decline in circulating endotoxin, interleukin (IL)-6, C-reactive protein (CRP), fibrinogen, and an increase in cholesterol levels. Except for a transient and reversible increase of prothrombin time, no adverse events were observed in patients undergoing this new adsorption apheresis treatment. Our data show that reduction of endotoxin by extracorporeal DEAE-cellulose-based plasma treatment may prove a promising therapeutic tool for patients suffering from bacterial sepsis and proven endotoxemia.
Bengsch
Stefan
S
Institute of Clinical Chemistry , Klinikum Grosshadern, Ludwig-Marimilians University, 81377 Munich, Germany. stefan.bengsch@med.uni-muenchen.de
Boos
Karl-Siegfried
KS
Nagel
Dorothea
D
Seidel
Dietrich
D
Inthorn
Dietrich
D
D018806:APACHE; D000327:Adsorption; D000368:Aged; D001781:Blood Component Removal; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D002482:Cellulose / Q000737:chemistry; D002784:Cholesterol / Q000378:metabolism; D003636:DEAE-Cellulose / Q000737:chemistry; D019446:Endotoxemia / Q000628:therapy; D004731:Endotoxins / Q000378:metabolism*; D004926:Escherichia coli / Q000378:metabolism; D004983:Ethanolamines / Q000737:chemistry; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007249:Inflammation; D015850:Interleukin-6 / Q000097:blood; D008070:Lipopolysaccharides / Q000737:chemistry / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000494:pharmacology; D010865:Pilot Projects; D010956:Plasmapheresis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000628:therapy; D013997:Time Factors
D004731:Endotoxins; D004983:Ethanolamines; D015850:Interleukin-6; D008070:Lipopolysaccharides; D005340:Fibrinogen; D002482:Cellulose; D002097:C-Reactive Protein; D003636:DEAE-Cellulose; D002784:Cholesterol; C007369:2-diethylaminoethanol; D009638:Norepinephrine