The limitations of endotoxin hemoadsorption therapy (PMX-DHP) and the optimal time to start PMX-DHP were examined in patients with septic multiple organ failure with hypercytokinemia (IL-6 > 1000 pg/ml). This study included 66 patients with infectious systemic inflammatory response syndrome in whom IL-6 > 1000 pg/ml before PMX-DHP therapy. These subjects were separated into two groups, those who survived for more than 28 days after the start of PMX-DHP therapy (S group; 38 patients) and those who did not survive (N-S group; 28 patients). Severity of symptoms and background factors, hemodynamic parameters, PaO2/FiO2, endotoxin, cytokines (TNF-α, IL-6, IL-1ra), and vascular endothelial cell function-related markers (ICAM-1, ELAM-1, PAI-1) were examined before and after PMX-DHP. Statistical analyses were performed by chi-squared test for background factors, with Wilcoxon's signed rank test for comparison within a group, and Mann–Whitney's U test for comparison between groups. This study was approved by the IRB of Tokyo Medical University.
Results
The APACHE-II score was 22.9 ± 6.3 and 30.7 ± 8.9, and the SOFA score was 9.7 ± 3.6 and 12.6 ± 3.4 in the S and N-S groups, respectively, showing significantly higher scores in the N-S group. The number of days that had lapsed from the onset of shock to PMX-DHP initiation was 0.8 ± 0.8 days in the S group while it was longer (1.8 ± 1.2 days) in the N-S group. After PMX-DHP for 2 hours, the endotoxin level decreased from 26.1 ± 20.3 to 20.3 ± 24.5 pg/ml with statistical significance (P < 0.05) in the S group. In the N-S group, it tended to decrease from 23.6 ± 20.3 to 10.9 ± 17.2 pg/ml.
Conclusion
These results suggest that PMX-DHP could save more lives in patients with septic multiple organ failure with IL-6> 1000 pg/ml when applied early after the onset of shock.