Endotoxin adsorption using polymyxin B immobilized fiber cartridges in severe sepsis patients following cardiac surgery.

INTRODUCTION: 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.

Prognostic value of endotoxin activity assay in patients with severe sepsis after cardiac surgery.

BACKGROUND: To evaluate the prognostic value of endotoxin activity assay (EAA) in adult patients with suspected or proven severe sepsis after cardiac surgery METHODS: Blood samples taken from 81 patients immediately after the diagnosis of severe sepsis were tested with the EAA. Patients were divided into 3 groups: low (<0.4, n = 20), moderate (0.4-0.59, n = 35) and high (≥0.6, n = 26) EAA levels. RESULTS: Gram-negative bacteraemia was found in 19/55 (35%) of cases with ЕАА <0.6 and in 11/26 (42%) of cases with higher ЕАА, p = 0.67. Mortality at 28 days in Groups 1, 2 and 3 was 20%, 43% and 54%, respectively. Patients with an EAA higher than 0.65 had a higher 28-day mortality than those with lower EAA values (18/26 - 69% vs. 19/55 - 34.5%; p = 0.0072). ROC analysis for the prediction of 28-day mortality revealed an AUC for APACHE II scores, EAA and PCT of 0.81, 0.73 and 0.66, respectively. CONCLUSIONS: EАА might be useful for recognising patients who have an increased risk of mortality due to severe sepsis.