Skip to main content

Advertisement

SpringerLink
Log in

Direct hemoperfusion with polymyxin-B-immobilized fiber columns improves septic hypotension and reduces inflammatory mediators in septic patients with colorectal perforation

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Although some studies have reported favorable effects of direct hemoperfusion with polymyxin-B-immobilized fiber columns (PMX) for the treatment of septic shock, few studies have demonstrated the efficacy of PMX in studies with a uniform case definition and without any other blood purification techniques.

Materials and methods

Fifty-two patients with severe sepsis or septic shock secondary to colorectal perforation were treated with PMX. Hemodynamic alterations and plasma concentrations of endotoxin, interleukin (IL)-1β, IL-1 receptor antagonist (IL-1Ra), IL-6, IL-8, and IL-10 were evaluated following PMX treatment.

Results

We observed a significant reduction in plasma endotoxin in the nonsurvivors immediately after PMX treatment compared to before treatment. Systolic blood pressure was markedly increased and circulating levels of IL-1β, IL-1Ra, and IL-8 were significantly reduced during a 2-h interval of PMX.

Conclusions

Our findings suggested that PMX treatment appears to adsorb endotoxin and also modulates circulating cytokine during a 2-h interval of direct hemoperfusion in septic patients with such condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Baue AE, Durham R, Faist E (1998) Systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), multiple organ failure (MOF): are we winning the battle? Shock 10:79–89 doi:10.1097/00024382-199808000-00001

    Article  PubMed  CAS  Google Scholar 

  2. Hynninen M, Wennervirta J, Leppaniemi A et al (2008) Organ dysfunction and long term outcome in secondary peritonitis. Langenbecks Arch Surg 393:81–86 doi:10.1007/s00423-007-0160-y

    Article  PubMed  CAS  Google Scholar 

  3. Schoenberg MH, Weiss M, Radermacher P (1998) Outcome of patients with sepsis and septic shock after ICU treatment. Langenbecks Arch Surg 383:44–48 doi:10.1007/s004230050090

    Article  PubMed  CAS  Google Scholar 

  4. Beutler B (2003) Science review: key inflammatory and stress pathways in critical illness—the central role of the toll-like receptors. Crit Care 7:39–46 doi:10.1186/cc1828

    Article  PubMed  Google Scholar 

  5. Jacob P, Mueller MH, Hahn J et al (2007) Alterations of neuropeptides in the human gut during peritonitis. Langenbecks Arch Surg 392:267–271 doi:10.1007/s00423-007-0168-3

    Article  PubMed  CAS  Google Scholar 

  6. Kamei K, Nimura Y, Nagino M et al (2002) Surgical stress reduces mortality from endotoxin shock. Langenbecks Arch Surg 386:512–517 doi:10.1007/s00423-001-0261-y

    Article  PubMed  Google Scholar 

  7. Marra MN, Thornton MB, Snable JL et al (1994) Endotoxin-binding and -neutralizing properties of recombinant bactericidal/permeability-increasing protein and monoclonal antibodies HA-1A and E5. Crit Care Med 22:559–565 doi:10.1097/00003246-199404000-00009

    Article  PubMed  CAS  Google Scholar 

  8. Shimizu T, Endo Y, Tsuchihashi H et al (2006) Endotoxin apheresis for sepsis. Transfus Apheresis Sci 35:271–282 doi:10.1016/j.transci.2006.06.006

    Article  Google Scholar 

  9. Aoki H, Kodama M, Tani T et al (1994) Treatment of sepsis by extracorporeal elimination of endotoxin using polymyxin B-immobilized fiber. Am J Surg 167:412–417 doi:10.1016/0002-9610(94)90126-0

    Article  PubMed  CAS  Google Scholar 

  10. Sato T, Shoji H, Koga N (2003) Endotoxin adsorption by polymyxin B immobilized fiber column in patients with systemic inflammatory response syndrome: the Japanese experience. Ther Apher Dial 7:252–258 doi:10.1046/j.1526-0968.2003.00006.x

    Article  PubMed  Google Scholar 

  11. Vincent JL, Laterre PF, Cohen J et al (2005) A pilot-controlled study of a polymyxin B-immobilized hemoperfusion cartridge in patients with severe sepsis secondary to intra-abdominal infection. Shock 23:400–405 doi:10.1097/01.shk.0000159930.87737.8a

    Article  PubMed  CAS  Google Scholar 

  12. Cruz DN, Perazella MA, Bellomo R et al (2007) Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Crit Care 11:R47 doi:10.1186/cc5780

    Article  PubMed  Google Scholar 

  13. Ono S, Tsujimoto H, Matsumoto A et al (2004) Modulation of human leukocyte antigen-DR on monocytes and CD16 on granulocytes in patients with septic shock using hemoperfusion with polymyxin B-immobilized fiber. Am J Surg 188:150–156 doi:10.1016/j.amjsurg.2003.12.067

    Article  PubMed  CAS  Google Scholar 

  14. Kojika M, Sato N, Yaegashi Y et al (2006) Endotoxin adsorption therapy for septic shock using polymyxin B-immobilized fibers (PMX): evaluation by high-sensitivity endotoxin assay and measurement of the cytokine production capacity. Ther Apher Dial 10:12–18 doi:10.1111/j.1744-9987.2006.00340.x

    Article  PubMed  CAS  Google Scholar 

  15. Anonymous (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874

  16. Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377 doi:10.1056/NEJMoa010307

    Article  PubMed  CAS  Google Scholar 

  17. Dellinger RP (2003) Cardiovascular management of septic shock. Crit Care Med 31:946–955 doi:10.1097/01.CCM.0000057403.73299.A6

    Article  PubMed  Google Scholar 

  18. Dellinger RP, Carlet JM, Masur H et al (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873 doi:10.1097/01.CCM.0000117317.18092.E4

    Article  PubMed  Google Scholar 

  19. Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710 doi:10.1007/BF01709751

    Article  PubMed  CAS  Google Scholar 

  20. Ikeda T, Ikeda K, Nagura M et al (2004) Clinical evaluation of PMX-DHP for hypercytokinemia caused by septic multiple organ failure. Ther Apher Dial 8:293–298 doi:10.1111/j.1526-0968.2004.00167.x

    Article  PubMed  CAS  Google Scholar 

  21. Shimizu T, Tani T, Hanasawa K et al (2001) The role of bacterial translocation on neutrophil activation during hemorrhagic shock in rats. Shock 16:59–63

    Article  PubMed  CAS  Google Scholar 

  22. Horiuchi A, Watanabe Y, Doi T et al (2007) Evaluation of prognostic factors and scoring system in colonic perforation. World J Gastroenterol 13:3228–3231

    PubMed  Google Scholar 

  23. Anwar MA, D’Souza F, Coulter R et al (2006) Outcome of acutely perforated colorectal cancers: experience of a single district general hospital. Surg Oncol 15:91–96 doi:10.1016/j.suronc.2006.09.001

    Article  PubMed  Google Scholar 

  24. Pavlidis TE, Marakis G, Ballas K et al (2006) Safety of bowel resection for colorectal surgical emergency in the elderly. Colorectal Dis 8:657–662 doi:10.1111/j.1463-1318.2006.00993.x

    Article  PubMed  CAS  Google Scholar 

  25. Biondo S, Ramos E, Fraccalvieri D et al (2006) Comparative study of left colonic Peritonitis Severity Score and Mannheim Peritonitis Index. Br J Surg 93:616–622 doi:10.1002/bjs.5326

    Article  PubMed  CAS  Google Scholar 

  26. Nemoto H, Nakamoto H, Okada H et al (2001) Newly developed immobilized polymyxin B fibers improve the survival of patients with sepsis. Blood Purif 19:361–368 doi:10.1159/000046966

    Article  PubMed  CAS  Google Scholar 

  27. Hanasawa K, Tani T, Kodama M (1989) New approach to endotoxic and septic shock by means of polymyxin B immobilized fiber. Surg Gynecol Obstet 168:323–331

    PubMed  CAS  Google Scholar 

  28. Jaber BL, Barrett TW, Cendoroglo NM et al (1998) Endotoxin removal by polymyxin-B immobilized polystyrene-derivative fibers during in vitro hemoperfusion of 10% human plasma. ASAIO J 44:54–61 doi:10.1097/00002480-199801000-00012

    Article  PubMed  CAS  Google Scholar 

  29. Hussein MH, Kato T, Sugiura T et al (2005) Effect of hemoperfusion using polymyxin B-immobilized fiber on IL-6, HMGB-1, and IFN gamma in a neonatal sepsis model. Pediatr Res 58:309–314 doi:10.1203/01.PDR.0000169995.25333.F7

    Article  PubMed  CAS  Google Scholar 

  30. Cohen J (2000) The detection and interpretation of endotoxaemia. Intensive Care Med 26(Suppl 1):S51–S56 doi:10.1007/s001340051119

    Article  PubMed  Google Scholar 

  31. Obata T, Nomura M, Kase Y et al (2008) Early detection of the Limulus amebocyte lysate reaction evoked by endotoxins. Anal Biochem 373:281–286 doi:10.1016/j.ab.2007.09.018

    Article  PubMed  CAS  Google Scholar 

  32. Marshall JC, Walker PM, Foster DM et al (2002) Measurement of endotoxin activity in critically ill patients using whole blood neutrophil dependent chemiluminescence. Crit Care 6:342–348 doi:10.1186/cc1522

    Article  PubMed  Google Scholar 

  33. Shimizu T, Hanasawa K, Tani T et al (2003) Changes in circulating levels of calcitonin gene-related peptide and nitric oxide metabolites in septic patients during direct hemoperfusion with polymyxin B-immobilized fiber. Blood Purif 21:237–243 doi:10.1159/000070696

    Article  PubMed  CAS  Google Scholar 

  34. Tani T, Hanasawa K, Endo Y et al (1998) Therapeutic apheresis for septic patients with organ dysfunction: hemoperfusion using a polymyxin B immobilized column. Artif Organs 22:1038–1044 doi:10.1046/j.1525-1594.1998.06086.x

    Article  PubMed  CAS  Google Scholar 

  35. Arnalich F, Hernanz A, Jimenez M et al (1996) Relationship between circulating levels of calcitonin gene-related peptide, nitric oxide metabolites and hemodynamic changes in human septic shock. Regul Pept 65:115–121 doi:10.1016/0167-0115(96)00080-8

    Article  PubMed  CAS  Google Scholar 

  36. Sakamoto A, Matsumura J, Mii S et al (2004) A prostaglandin E2 receptor subtype EP4 agonist attenuates cardiovascular depression in endotoxin shock by inhibiting inflammatory cytokines and nitric oxide production. Shock 22:76–81 doi:10.1097/01.shk.0000129338.99410.5d

    Article  PubMed  CAS  Google Scholar 

  37. Wanner GA, Stockle V, Bauer M et al (1999) Differential gene expression of CINC, NOS II, and ICAM-1 in endotoxemic liver cells by rG-CSF. Langenbecks Arch Surg 384:216–221 doi:10.1007/s004230050195

    Article  PubMed  CAS  Google Scholar 

  38. Nakamura T, Kawagoe Y, Matsuda T et al (2004) Effect of polymyxin B-immobilized fiber on bone resorption in patients with sepsis. Intensive Care Med 30:1838–1841 doi:10.1007/s00134-004-2357-7

    Article  PubMed  Google Scholar 

  39. Wang Y, Liu Y, Sarker KP et al (2000) Polymyxin B binds to anandamide and inhibits its cytotoxic effect. FEBS Lett 470:151–155 doi:10.1016/S0014-5793(00)01313-2

    Article  PubMed  CAS  Google Scholar 

  40. Tsuzuki H, Tani T, Ueyama H et al (2001) Lipopolysaccharide: neutralization by polymyxin B shuts down the signaling pathway of nuclear factor kappaB in peripheral blood mononuclear cells, even during activation. J Surg Res 100:127–134 doi:10.1006/jsre.2001.6227

    Article  PubMed  CAS  Google Scholar 

  41. Suzuki H, Nemoto H, Nakamoto H et al (2002) Continuous hemodiafiltration with polymyxin-B immobilized fiber is effective in patients with sepsis syndrome and acute renal failure. Ther Apher 6:234–240 doi:10.1046/j.1526-0968.2002.00416.x

    Article  PubMed  CAS  Google Scholar 

  42. Kohro S, Imaizumi H, Yamakage M et al (2006) Anandamide absorption by direct hemoperfusion with polymyxin B-immobilized fiber improves the prognosis and organ failure assessment score in patients with sepsis. J Anesth 20:11–16 doi:10.1007/s00540-005-0366-5

    Article  PubMed  Google Scholar 

  43. Kadoi Y, Hinohara H, Kunimoto F et al (2005) Cannabinoid antagonist AM 281 reduces mortality rate and neurologic dysfunction after cecal ligation and puncture in rats. Crit Care Med 33:2629–2636 doi:10.1097/01.CCM.0000187010.14426.CC

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

We would like to thank Masakazu Tsuchiya and Shinji Satomura at Wako Pure Chemical Industries, Ltd. Osaka, Japan for providing Endotoxin Test Wako, Sample Pretreatment Solution, the tube reader (Toxinometer MT251), and the measurement techniques.

Author information

Authors and Affiliations

  1. Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan

    Tomoharu Shimizu, Kazuyoshi Hanasawa, Yoshihiro Endo & Tohru Tani

  2. Department of Critical and Emergency Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan

    Yutaka Eguchi

  3. Juntendo University Shizuoka Hospital, Shizuoka, Japan

    Koichi Sato

  4. Hyogo Prefectural Awaji Hospital, Sumoto, Hyogo, Japan

    Masahiko Umeki

  5. Shinkoga Hospital, Saga, Japan

    Nobuhiko Koga

  6. Saiseikai Matsusaka General Hospital, Matsusaka, Mie, Japan

    Tatsushi Naganuma

  7. Saga University Hospital, Saga, Japan

    Seiji Sato

  8. Takagi Hospital, Fukuoka, Japan

    Tomonori Shimonishi

  9. Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan

    Toshiaki Ikeda & Naoto Matsuno

  10. National Defense Medical College, Tokorozawa, Japan

    Satoshi Ono

  11. Kanazawa Medical University, Kanazawa, Japan

    Hitoshi Saitoh

  12. Higashiyamato Hospital, Tokyo, Japan

    Koshi Satoh

  13. Sagamidai Hospital, Zama, Kanagawa, Japan

    Yoshimasa Otani

Authors
  1. Tomoharu Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuyoshi Hanasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Koichi Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masahiko Umeki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nobuhiko Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tatsushi Naganuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seiji Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomonori Shimonishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Toshiaki Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Naoto Matsuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Satoshi Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hitoshi Saitoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Koshi Satoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yoshimasa Otani
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yoshihiro Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Yutaka Eguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Tohru Tani
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

PMX treatment study group

Corresponding author

Correspondence to Tohru Tani.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shimizu, T., Hanasawa, K., Sato, K. et al. Direct hemoperfusion with polymyxin-B-immobilized fiber columns improves septic hypotension and reduces inflammatory mediators in septic patients with colorectal perforation. Langenbecks Arch Surg 394, 303–311 (2009). https://doi.org/10.1007/s00423-008-0395-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-008-0395-2

Keywords

Search

Navigation