title: Endotoxin adsorption using polymyxin B immobilized fiber cartridges in severe sepsis patients following cardiac surgery.
abstract: BACKGROUND
  Sepsis still represents an obstacle in modern medicine. The purpose of this study was to evaluate the safety and effectiveness of selective lipopolysaccharide (LPS)-adsorption therapy using polymyxin B immobilized fiber cartridges in adult patients complicated with severe sepsis after cardiac surgery.
  
  
  METHODS
  65 patients received extracorporeal LPS-adsorption procedures using Toraymyxin columns (PMX; Toray, Tokyo, Japan) in addition to the standard treatment according to the Surviving Sepsis Campaign guidelines. The inclusion criteria were clinical signs of severe sepsis, endotoxin activity assay (EAA)≥0.6, and blood plasma procalcitonin (PCT)>2 ng/ml. For the control group, we selected 40 patients who were comparable with the study group but who received only the standard therapy.
  
  
  RESULTS
  Each patient received 2 standard LPS-adsorption procedures (lasting for 120 min each). After the LPS-adsorption course, we noted any indices of hemodynamic improvements, including an increase in mean arterial pressure from 73 to 89 mmHg (p<0.001), mean oxygenation index (213-265, p<0.001. We observed a decrease in LPS concentrations by the EAA (0.71-0.55, p<0.001) and by the LAL test (1.44-0.36 EU/ml, p<0.001). In the control group, there were no significant changes in any of the studied parameters. Moreover, the 28-day mortality was 42% in the study group and 65% in the control group (p=0.032). The endotoxin adsorption procedures were not associated with any adverse reactions, and specifically, no extracorporeal circuit thrombosis cases were noted.
  
  
  CONCLUSIONS
  Selective LPS-adsorption is a safe and possibly effective adjunctive treatment method for severe sepsis patients.
authors.affiliation: Bourakovsky Institute for Cardiac Surgery, Bakoulev Scientific Center for Cardiovascular Surgery, Moscow - Russian Federation.
authors.forename: Michail
authors.initials: M
authors.lastname: Yaroustovsky
authors.forename: Marina
authors.initials: M
authors.lastname: Abramyan
authors.forename: Nickolay
authors.initials: N
authors.lastname: Krotenko
authors.forename: Dmitry
authors.initials: D
authors.lastname: Popov
authors.forename: Marina
authors.initials: M
authors.lastname: Plyushch
authors.forename: Zakhar
authors.initials: Z
authors.lastname: Popok
mesh_terms: D000327:Adsorption; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016022:Case-Control Studies; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006464:Hemoperfusion / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004731:Endotoxins; D011112:Polymyxin B