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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2018

Open Access 01-12-2018 | Research

Impact of hemoperfusion with polymyxin B added to hemofiltration in patients with endotoxic shock: a case–control study

Authors: Ana Navas, Ricard Ferrer, Maria Luisa Martínez, Gemma Gomà, Gisela Gili, Jordi Masip, David Suárez, Antonio Artigas

Published in: Annals of Intensive Care | Issue 1/2018

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Abstract

Background

Septic shock is a leading cause of death in critical patients. In patients with gram-negative septic shock, hemoperfusion with polymyxin B aims to remove endotoxins from plasma. We analyzed the clinical and biological response to hemoperfusion in patients with septic shock and acute kidney injury.

Methods

This prospective case–control study in the medical–surgical intensive care unit of a university hospital included consecutive adults patients with septic shock and suspected gram-negative bacteria infection with elevated plasma endotoxin activity (EAA > 0.6 EU/ml) and acute kidney injury requiring continuous renal replacement therapy (CRRT). At onset of septic shock, half underwent CRRT plus hemoperfusion with polymyxin B for two hours a day during two consecutive days (hemoperfusion group) and half received only CRRT (control group). We measured clinical, physiological, and biological parameters (EAA, C-reactive protein, procalcitonin, and cytokines) daily during the first 5 days.

Results

We included 18 patients (male, 33%; mean age, 67.5; mean SOFA score, 11.3). Abdominal infections predominated (50% had peritonitis). At the beginning of CRRT, RIFLE classification was “failure” for 72% and “injury” for 28%. Baseline characteristics did not differ between groups. Patients in the hemoperfusion group required longer mechanical ventilation (12.4 vs. 9.4 days, p = 0.03) and CRRT (8.5 vs. 6 days, p = 0.01) than in the control group. Noradrenaline doses, lactate, procalcitonin, and C-reactive protein decreased in both groups. At day 5, EAA was significantly lower in the hemoperfusion group (0.58 EU/ml vs. 0.73 EU/ml in controls, p = 0.03). There were no significant differences between groups in other biomarkers or ICU mortality (33.3% in the treatment group vs. 44.4% in the control group, p = 0.5). No adverse effects of hemoperfusion were observed.

Conclusions

Hemoperfusion with polymyxin B added to CRRT resulted in faster decrease in endotoxin levels, but we observed no improvements in clinical, physiological, or biological parameters.
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Literature
1.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–10.CrossRefPubMed
2.
Opal SM. The host response to endotoxin, antilipopolysaccharide strategies, and the management of severe sepsis. Int J Med Microbiol. 2007;297:365–77.CrossRefPubMed
3.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock. Intensive Care Med. 2017;43:304–77.CrossRefPubMed
4.
Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, et al. VA/NIH Acute Renal Failure Trial Network. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20.CrossRefPubMed
5.
Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med. 2016;375:122–33.CrossRefPubMed
6.
Payen D, Mateo J, Cavaillon JM, Fraisse F, Floriot C, Vicaut E. Impact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: a randomized controlled trial. Crit Care Med. 2009;37:803–10.CrossRefPubMed
7.
Joannes-Boyau O, Honoré PM, Perez P, Bagshaw SM, Grand H, Canivet JL, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Med. 2013;39:1535–46.CrossRefPubMed
8.
9.
Romaschin AD, Harris DM, Ribeiro MB, Paice J, Foster DM, Walker PM, Marshall JC. A rapid assay of endotoxin in whole blood using autologous neutrophil dependent chemiluminescence. J Immunol Methods. 1998;212:169–85.CrossRefPubMed
10.
Marshall JC, Walker PM, Foster DM, Harris D, Ribeiro M, Paice J, et al. Measurement of endotoxin activity in critically ill patients using whole blood neutrophil dependent chemiluminescence. Crit Care. 2002;6:342–8.CrossRefPubMedPubMedCentral
11.
Marshall JC, Foster D, Vincent JL, Cook DJ, Cohen J, Dellinger RP, et al. Diagnostic and prognostic implications of endotoxemia in critical illness: results of the MEDIC study. J Infect Dis. 2004;190:527–34.CrossRefPubMed
12.
Aoki H, Kodama M, Tani T, Hanasawa K. Treatment of sepsis by extracorporeal elimination of endotoxin using polymyxin B-immobilized fiber. Am J Surg. 1994;167:412–7.CrossRefPubMed
13.
Ronco C, Brendolan A, Dan M, Piccinni P, Bellomo R, De Nitti C, et al. Adsorption in sepsis. Kidney Int Suppl. 2000;76:S148–55.CrossRefPubMed
14.
Shoji H, Tani T, Hanasawa K, Kodama M. Extracorporeal endotoxin removal by polymyxin-B immobilized fiber cartridge: designing and antiendotoxin efficacy in the clinical application. Ther Apher. 1998;2:3–12.CrossRefPubMed
15.
Shoji H. Extracorporeal endotoxin removal for the treatment of sepsis: endotoxin adsorption cartridge (Toraymyxin). Ther Apher Dial. 2003;7:108–14.CrossRefPubMed
16.
Vincent JL, Laterre PF, Cohen J, Burchardi H, Bruining H, Lerma FA, et al. A pilot-controlled study of a polymyxin B-immobilized hemoperfusion cartridge in patients with severe sepsis secondary to intra-abdominal infection. Shock. 2005;23:400–5.CrossRefPubMed
17.
Cruz DN, Perazella MA, Bellomo R, de Cal M, Polanco N, Corradi V, et al. Effectiveness of polymyxin B-immobilized fiber column in sepsis; a systematic review. Crit Care. 2007;11:R47.CrossRefPubMedPubMedCentral
18.
Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA. 2009;301:2445–52.CrossRefPubMed
19.
Payen DM, Guilhot J, Launey Y, Lukaszewicz AC, Kaaki M, Veber B, et al. Early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: a multicenter randomized control trial. Intensive Care Med. 2015;41:975–84.CrossRefPubMedPubMedCentral
20.
Zhou F, Peng Z, Murugan R, Kellum JA. Blood purification and mortality in sepsis: a meta-analysis of randomized trials. Crit Care Med. 2013;41:2209–20.CrossRefPubMedPubMedCentral
21.
Dellinger RP, Bagshaw SM, Antonelli M, Foster D, Klein DJ, Marshall J, et al. Effect of targeted polymyxin B hemoperfusion on 28-day mortality in patients with septic shock and elevated endotoxin level. The EUPHRATES randomized clinical trial. JAMA. 2018;320(14):1455–63.CrossRefPubMed
22.
23.
Tani T, Hanasawa K, Kodama M, Imaizumi H, Yonekawa M, Saito M, et al. Correlation between plasma endotoxin, plasma cytokines, and plasminogen activator inhibitor-1 activities in septic patients. World J Surg. 2001;25:660–8.CrossRefPubMed
24.
Nakamura T, Matsuda T, Suzuki Y, Shoji H. Polymyxin B-immobilized fiber hemoperfusion in patients with sepsis. Dial Transplant. 2003;32:602–7.
25.
Zagli G, Bonizzoli M, Spina R, Cianchi G, Pasquini A, Anichini V, et al. Effects of hemoperfusion with an immobilized polymyxin-B fiber column on cytokine plasma levels in patients with abdominal sepsis. Minerva Anestesiol. 2010;76:405–12.PubMed
26.
Shimizu T, Hanasawa K, Sato K, Umeki M, Koga N, Naganuma T, et al. The clinical significance of serum procalcitonin levels following direct hemoperfusion with polymyxin B-immobilized fiber column in septic patients with colorectal perforation. Eur Surg Res. 2009;42:109–17.CrossRefPubMed
27.
Yaroustovsky M, Abramyan M, Krotenko N, Popov D, Plyushch M, Popok Z. Endotoxin adsorption using polymyxin B immobilized fiber cartridges in severe sepsis patients following cardiac surgery. Int J Artif Organs. 2014;37:299–307.CrossRefPubMed
28.
Yaroustovsky M, Abramyan M, Krotenko N, Popov D, Plyushch M, Rogalskaya E, Nazarova H. Combined extracorporeal therapy for severe sepsis in patients after cardiac surgery. Blood Purif. 2014;37:39–46.CrossRefPubMed
29.
Bobek I, Gong D, De Cal M, Cruz D, Chionh CY, Haapio M, et al. Removal of neutrophil gelatinase-associated lipocalin by extracorporeal therapies. Hemodial Int. 2010;14:302–7.CrossRefPubMed
30.
Suberviola B, Castellanos-Ortega A, Ruiz Ruiz A, Lopez-Hoyos M, Santibañez M. Hospital mortality prognostication in sepsis using the new biomarkers suPAR and proADM in a single determination on ICU admission. Intensive Care Med. 2013;39:1945–52.CrossRefPubMed
31.
Iwagami M, Yasunaga H, Doi K, Horiguchi H, Fushimi K, Matsubara T, et al. Postoperative polymyxin b hemoperfusion and mortality in patients with abdominal septic shock: a propensity-matched analysis. Crit Care Med. 2014;42:1187–93.CrossRefPubMed
32.
Romaschin A, Obieuz-Foster C, Shoji H, Klein D. Novel insights into the direct removal of endotoxin by polymyxin B hemoperfusion. Blood Purif. 2017;44:193–7.CrossRefPubMed
33.
Chang T, Tu YK, Lee CT, Chao A, Huang CH, Wang MJ, Yeh YC. Effects of Polymyxin B hemoperfusion on mortality in patients with severe sepsis and septic shock: a systemic review, meta-analysis update, and disease severity subgroup meta-analysis. Crit Care Med. 2017;45:e858–64.CrossRefPubMedPubMedCentral
34.
Fujii T, Ganeko R, Kataoka Y, Furukawa TA, Featherstone R, Doi K, et al. Polymyxin B-immobilized hemoperfusion and mortality in critically ill adult patients with sepsis/septic shock: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Med. 2018;44:167–78.CrossRefPubMed
35.
Atan R, Crosbie DC, Bellomo R. Techniques of extracorporeal cytokine removal: a systematic review of human studies. Ren Fail. 2013;35:1061–70.CrossRefPubMed
36.
Coudroy R, Payen D, Launey Y, Lukaszewicz AC, Kaaki M, Veber B, et al. Modulation by polymyxin-B hemoperfusion of inflammatory response related to severe peritonitis. Shock. 2017;47:93–9.CrossRefPubMed
37.
Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstädt H, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA. 2016;315:2190–9.CrossRefPubMed
38.
39.
Kellum J, Lameire N, Aspelin P, Barsoum R, Burdmann E, Goldstein S, et al. Kidney disease: improving global outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–126.CrossRef
Metadata
Title
Impact of hemoperfusion with polymyxin B added to hemofiltration in patients with endotoxic shock: a case–control study
Authors
Ana Navas
Ricard Ferrer
Maria Luisa Martínez
Gemma Gomà
Gisela Gili
Jordi Masip
David Suárez
Antonio Artigas
Publication date
01-12-2018
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2018
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-018-0465-8

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