title: Effects of hemoperfusion with an immobilized polymyxin-B fiber column on cytokine plasma levels in patients with abdominal sepsis.
abstract: OBJECTIVE
  The beneficial role of hemofiltration with immobilized polymyxin-B fiber (PMX) columns in sepsis, especially sepsis due to gram-negative bacteria, has previously been emphasized. Although the efficacy of PMX-B fiber-mediated hemofiltration in reducing plasma levels of cytokines has been reported, other studies did not confirm this observation. Here we report the effects of PMX-B fiber-mediated hemofiltration on outcome and cytokine plasma levels in patients with abdominal sepsis.
  
  
  METHODS
  Twelve consecutive patients admitted to the Intensive Care Unit (October 2006-December 2007) for severe sepsis/septic shock from abdominal infection were treated with standard therapy and 2 cycles of hemofiltration with PMX cartridges. Clinical data and plasma levels of IL-6, IL-10 and TNF-a were measured 24 hours before and after PMX treatment.
  
  
  RESULTS
  Plasma concentrations (pg/mL) of IL-6, IL-10 and TNF-a were significantly lower after hemofiltration with a PMX fiber column (279.9+/-69.2 vs. 130.9+/-18.4, 166.4+/-36.7 vs. 45.5+/-12.2, 83.1+/-13.5 vs. 23.9+/-5.1 pg/mL, respectively; P<0.05). After treatment, patients required lower doses of norepinephrine (0.3+/-0.1 vs. 0.8+/-0.1 mg/kg/min) and reduced lactate levels, recovery of respiratory function and improved Simplified Organ Failure Assessment (SOFA) scores. After 28 days, 6 patients (50%) had survived. Subgroup analysis demonstrated that survivors had higher IL-6 and lower IL-10 and TNF-a pre-treatment plasma levels (pg/mL) compared with deceased patients (324.4+/-41.1 vs.235.3+/-38.4; 98.5+/-16.1 vs. 234.3+/-48.6, 44.5+/-9.0 vs.121.6+/-52.3 pg/mL, respectively; P<0.05). No adverse events imputable to the treatment were recorded.
  
  
  CONCLUSIONS
  Hemofiltration with a PMX fiber column was able to reduce plasma levels of IL-6, IL-10 and TNF-a, especially in patients surviving at 28 days. Use of the technique was associated with lower norepinephrine support and an increased PaO2/FiO2 ratio.
authors.affiliation: Intensive Care Unit of Emergency Department, Careggi Teaching Hospital and University of Florence, Florence, Italy. giovanni.zagli@unifi.it
authors.forename: G
authors.initials: G
authors.lastname: Zagli
authors.forename: M
authors.initials: M
authors.lastname: Bonizzoli
authors.forename: R
authors.initials: R
authors.lastname: Spina
authors.forename: G
authors.initials: G
authors.lastname: Cianchi
authors.forename: A
authors.initials: A
authors.lastname: Pasquini
authors.forename: V
authors.initials: V
authors.lastname: Anichini
authors.forename: S
authors.initials: S
authors.lastname: Matano
authors.forename: F
authors.initials: F
authors.lastname: Tarantini
authors.forename: A
authors.initials: A
authors.lastname: Di Filippo
authors.forename: E
authors.initials: E
authors.lastname: Maggi
authors.forename: A
authors.initials: A
authors.lastname: Peris
mesh_terms: D000005:Abdomen; D000328:Adult; D000368:Aged; D005260:Female; D006464:Hemoperfusion / Q000379:methods; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011112:Polymyxin B; D018805:Sepsis / Q000097:blood* / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D011112:Polymyxin B