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Zagli G. 1, Bonizzoli M. 1, Spina R. 1, Cianchi G. 1, Pasquini A. 1, Anichini V. 1, Matano S. 1, Tarantini F. 2, Di Filippo A. 2, Maggi E. 3, Peris A. 1
1Intensive Care Unit of Emergency Department, Careggi Teaching Hospital and University of Florence, Florence, Italy; 2Department of Critical Care Medicine and Surgery, Careggi Teaching Hospital and University of Florence, Florence, Italy; 3Department of Internal Medicine, University of Florence, Florence, Italy
AIM: The beneficial role of hemofiltration with immobilized polymyxin-B fiber (PMX) columns in sepsis, especially sepsis due to gram-negative bacteria, has previously been emphasized. Although the efficacy of PMX-B fiber-mediated hemofiltration in reducing plasma levels of cytokines has been reported, other studies did not confirm this observation. Here we report the effects of PMX-B fiber-mediated hemofiltration on outcome and cytokine plasma levels in patients with abdominal sepsis.
METHODS: Twelve consecutive patients admitted to the Intensive Care Unit (October 2006-December 2007) for severe sepsis/septic shock from abdominal infection were treated with standard therapy and 2 cycles of hemofiltration with PMX cartridges. Clinical data and plasma levels of IL-6, IL-10 and TNF-a were measured 24 hours before and after PMX treatment.
RESULTS: Plasma concentrations (pg/mL) of IL-6, IL-10 and TNF-a were significantly lower after hemofiltration with a PMX fiber column (279.9±69.2 vs. 130.9±18.4, 166.4±36.7 vs. 45.5±12.2, 83.1±13.5 vs. 23.9±5.1 pg/mL, respectively; P<0.05). After treatment, patients required lower doses of norepinephrine (0.3±0.1 vs. 0.8±0.1 mg/kg/min) and reduced lactate levels, recovery of respiratory function and improved Simplified Organ Failure Assessment (SOFA) scores. After 28 days, 6 patients (50%) had survived. Subgroup analysis demonstrated that survivors had higher IL-6 and lower IL-10 and TNF-a pre-treatment plasma levels (pg/mL) compared with deceased patients (324.4±41.1 vs.235.3±38.4; 98.5±16.1 vs. 234.3±48.6, 44.5±9.0 vs.121.6±52.3 pg/mL, respectively; P<0.05). No adverse events imputable to the treatment were recorded.
CONCLUSION: Hemofiltration with a PMX fiber column was able to reduce plasma levels of IL-6, IL-10 and TNF-a, especially in patients surviving at 28 days. Use of the technique was associated with lower norepinephrine support and an increased PaO2/FiO2 ratio.