Relationship between effect of polymyxin B-immobilized fiber and high-mobility group box-1 protein in septic shock patients.
Direct hemoperfusion (DHP) using a polymyxin B (PMX)-immobilized fiber column has been used for treatment of endotoxemia-induced septic shock in Japan since 1994 and is now an accepted therapy for reducing serum endotoxin levels. Although a reduction in inflammatory cytokines has been reported, the detailed mechanism of DHP-PMX is not known. We investigated the high-mobility group box-1 (HMGB-1) level in septic shock patients treated with DHP-PMX. Subjects (n = 20) were separated into two group: those whose systolic blood pressure increased to more than 30 mm Hg immediately after DHP-PMX (effective [E] group: nine cases) and those whose systolic blood pressure did not increase to more than 30 mm Hg (noneffective [N-E] group: 11 cases). The interleukin-6, plasminogen activator inhibitor-1, and HMGB-1 levels were measured in each group. The Pao2/Fio2 ratio and the Sepsis-Related Organ Failure Assessment (SOFA) score were also evaluated. Pretreatment interleukin-6, plasminogen activator inhibitor-1, and HMGB-1 levels were similar in the E and N-E groups, but mortality rate was significantly higher in the N-E group. Furthermore, posttreatment SOFA score was significantly lower in the E group. In the E group, only the HMGB-1 levels improved significantly after DHP-PMX. Present data suggest that the circulation dynamics of septic shock patients can be improved by reducing HMGB-1 levels by using DHP-PMX.
Sakamoto
Yuichiro
Y
Department of Emergency and Critical Care Medicine, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
Mashiko
Kunihiro
K
Matsumoto
Hisashi
H
Hara
Yoshiaki
Y
Kutsukata
Noriyoshi
N
Yamamoto
Yasuhiro
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D001794:Blood Pressure; D004731:Endotoxins / Q000097:blood; D005260:Female; D024243:HMGB1 Protein / Q000097:blood*; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000628:therapy; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011112:Polymyxin B; D011486:Protein C / Q000378:metabolism; D012772:Shock, Septic / Q000097:blood / Q000628:therapy*
D000900:Anti-Bacterial Agents; D004731:Endotoxins; D024243:HMGB1 Protein; D015850:Interleukin-6; D017395:Plasminogen Activator Inhibitor 1; D011486:Protein C; D011112:Polymyxin B