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      Hemoperfusion with Polymyxin B- Immobilized Fiber Attenuates the Increased Plasma Levels of Thrombomodulin and von Willebrand Factor from Patients with Septic Shock


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          Aims: The present study assessed whether plasma levels of thrombomodulin and von Willebrand factor (vWF) are altered in patients with septic shock and whether treatment with polymyxin B-immobilized fiber (PMX-F) affects these levels. Methods: Twenty-four patients with septic shock and 20 normal healthy controls were included in this study. Plasma levels of thrombomodulin and vWF were measured by enzyme immunoassay (EIA). The treatments with direct hemoperfusion using PMX-F column on patients with septic shock were repeated twice for 2 h each. Healthy controls were not subjected to hemoperfusion. Results: 13 of 24 patients with septic shock survived (survival rate was 54.2%). Levels of blood endotoxin decreased significantly from 41.2 ± 4.8 pg/ml at baseline to 13.2 ± 3.6 pg/ml after direct hemoperfusion. Systolic blood pressure increased significantly from 82 ± 6 mm Hg at baseline to 118 ± 12 mm Hg after treatment. The patients with septic shock demonstrated significantly increased plasma levels of thrombomodulin (p < 0.001) and vWF (p < 0.001) compared with those in healthy controls. These increased levels of plasma thrombomodulin and vWF in patients with septic shock decreased significantly after treatment with PMX-F (p < 0.01). Conclusion: These data suggest that plasma thrombomodulin and vWF may be related to septic shock and that PMX-F is effective in reducing these factors in patients with septic shock.

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          Treatment of sepsis by extracorporeal elimination of endotoxin using polymyxin B-immobilized fiber.

          Despite the use of potent antibiotics and intensive supportive care, mortality remains high among septic shock patients, especially those with endotoxemia. To remove endotoxin directly from the blood, a material consisting of polymyxin B that is immobilized on fibers (PMX-F) and that can selectively detoxify endotoxin was developed. In a preliminary clinical study, 16 patients with septic multiple organ failure were treated with direct hemoperfusion using a PMX-F column. This therapy significantly decreased the endotoxin level from 76 pg/mL to 21 pg/mL after 2 hours of direct hemoperfusion. The hyperdynamic state of the cardiac index, which is a characteristic of endotoxic shock, returned to normal levels after treatment. In septic shock patients with a systolic pressure of less than 100 mm Hg, the systolic arterial pressure increased significantly from the pretreatment level. The alleviation of fever caused by this therapy continued until the day after treatment. Of the 16 patients who underwent this therapy, 9 were alive 2 weeks after this therapy and 7 patients were discharged from the hospital alive. Hemoperfusion with PMX may be an effective treatment for sepsis and septic shock.

            Author and article information

            Blood Purif
            Blood Purification
            S. Karger AG
            August 1998
            23 September 1998
            : 16
            : 4
            : 179-186
            a Nephrology Unit, Misato Junshin Hospital, Saitama, b Department of Medicine, Koto Hospital, Tokyo, and c Artificial Organs Division, Toray Medical Co., Ltd., Tokyo, Japan
            14333 Blood Purif 1998;16:179–186
            © 1998 S. Karger AG, Basel

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            Page count
            Figures: 3, Tables: 1, References: 31, Pages: 8
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/14333
            Self URI (text/html): https://www.karger.com/Article/FullText/14333
            Self URI (journal page): https://www.karger.com/SubjectArea/Nephrology
            Original Paper

            Cardiovascular Medicine,Nephrology
            Cytokine,Endothelial cell,Endotoxemia,Polymyxin B-immobilized fiber


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