Effect of PMX-DHP according to differences in infection site
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KeywordsCatecholamine Septic Shock Vascular Endothelial Cell Biliary Tract Vascular Endothelium
PMX-DHP (Endotoxin adsorption method) is used for treatment of patients with sepsis and septic shock primarily caused by Gram negative infections, and its effectiveness has been evaluated in Japan. In this study, patients with septic shock caused by intra-peritoneal infections were classified as a group in which septic shock was caused by biliary tract infections (Group C) or a group in which septic shock was caused by perforation of the lower digestive tract (Group P). Both groups of patients were assessed for the clinical effect of PMX-DHP, inflammatory mediators and markers related to vascular endothelial cell function.
Cases in which PMX-DHP was performed consisted of seven in Group C (age: 69 ± 11 years; mean no of treatments: 1.6) and 18 in Group P (age: 73 ± 24 years; mean no of treatments: 1.5).
There were no significant differences observed in APACHE-II scores with Group C having a score of 28.9 ± 8.5 and Group P having a score of 27.1 ± 8.2.
However, Goris MOF scores were obviously higher in Group C, with a score of 8.5 ± 1.5 for Group C and a score of 4.9 ± 2.0 for group P. The number of days from the onset of shock until PMX-DHP was performed was also greater in Group C (1.6 ± 0.8 days versus 0.9 ± 0.8 days). Although blood pressure elevating effects were observed in both groups, the magnitude of those effects was higher in Group P. The amount of catecholamine use was also obviously greater in Group C than in Group P. Although Group C exhibited higher endotoxin (ET) values than Group P, there were no significant differences observed. The values of vascular endothelium markers (ICAM-1, ELAM-1, thrombomodulin, PAI-1 and NOx) before the start of PMX-DHP were higher in Group C. Although IL-6 tended to decrease before and after PMX-DHP in both groups, there were no significant differences observed. However, IL-6 in Group P demonstrated a significant decrease at 24 hours after PMX-DHP. IL-1ra tended to decrease before and after PMX-DHP in both groups, and values before and after PMX-DHP in Group P were roughly twice that of those in Group C.
Vascular endothelial cell activation and the degree of its impairment were considered to be greater in Group C than in Group P.