Skip to main content
SpringerLink
Log in

Effect of polymyxin B-immobilized fiber on bone resorption in patients with sepsis

  • Brief Report
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To analyze the effects of polymyxin B-immobilized fiber (PMX-F) on bone resorption in septic patients.

Design and setting

Observational prospective study in intensive care units of a general hospital.

Patients and participants

25 patients with severe sepsis and 20 healthy controls.

Measurements and results

Septic patients were randomly assigned to two groups: PMX-F treatment group (n=15) and conventional treatment group (n=10). Total pyridinium crosslink pyridinoline (PYD) and deoxypyridinoline (DPD) in urine were determined by modified high-performance liquid chromatography. Nitric oxide production was assessed by measuring the ratio of the nitric oxide breakdown products to urinary creatinine (NOx/Cr). Plasma endotoxin levels were determined by endospecy test. The blood albumin, ionized calcium, and parathyroid hormone were also measured. PMX-F treatment was performed twice separated by 24 h. Urinary NOx/Cr, PYD/Cr, and DPD/Cr were significantly increased in septic patients compared with those in healthy controls. Blood ionized calcium in septic patients was lower than in healthy controls, while parathyroid hormone levels in septic patients were higher than in healthy controls (P<0.01). PMX-F treatment reduced plasma endotoxin, urinary NOx/Cr, PYD/Cr, DPD/Cr, and serum parathyroid hormone levels and increased blood ionized calcium significantly; however, conventional treatment did not affect these levels.

Conclusions

Septic patients increased nitric oxide production and bone resorption, and PMX-F treatment is effective in reducing nitric oxide levels and bone resorption markers.

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

References

  1. Alberti C, Brun-Buissoh C, Burchardi H, Martin C, Goodman S, Artigas A, Sicignaho A, Palazzo M, Moreno R, Boulme R, Lepage E, Le Gall JR (2002) Epidermiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 28:108–121

    PubMed  Google Scholar 

  2. Aoki H, Kodama M, Tani T, Hanasawa K (1994) Treatment of sepsis by extracorporeal elimination of endotoxin using polymyxin B-immobilized fiber. Am J Surg 167:412–417

    Article  CAS  PubMed  Google Scholar 

  3. Nakamura T, Ebihara I, Shimada N, Koide H (1998) Changes in plasma erythropoietin and interleukin-6 concentrations in patients with septic shock after hemoperfusion with polymyxin B-immobilized fiber. Intensive Care Med 24:1272–1276

    Article  CAS  PubMed  Google Scholar 

  4. Rosenbrock H, Seifert-Klauss V, Kaspar S, Busch R, Luppa PB (2002) Changes of biochemical bone markers during the menopausal transition. Clin Chem Lab Med 40:143–151

    CAS  PubMed  Google Scholar 

  5. Smith LM, Cuthberton B, Harvie J, Webster N, Robins S, Ralston SH (2002) Increased bone resorption in the critically ill: association with sepsis and increased nitric oxide production. Crit Care Med 30:837–840

    Article  CAS  PubMed  Google Scholar 

  6. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:964–974

    Google Scholar 

  7. Nakamura T, Ushiyama C, Suzuki Y, Shoji H, Shimada N, Koide H (2002) Hemoperfusion with polymyxin B immobilized fibers for urinary albumin excretion in septic patients with trauma. ASAIO J 48:244–248

    Article  CAS  PubMed  Google Scholar 

  8. Nakamura T, Ushiyama C, Suzuki Y, Shoji H, Osada S, Shimada N, Koide H (2002) Effect of polymyxin B-immobilized fibre on various mediators in patients with hypothermic sepsis. Clin Intensive Care 12:223–228

    Google Scholar 

  9. Grabowski PS, England AJ, Dykhuizen R (1996) Elevated nitric oxide production in rheumatoid arthritis. Detection using the fasting urinary nitrate: creatinine ratio. Arthritis Rheum 39:643–647

    CAS  PubMed  Google Scholar 

  10. Green LC, Wagner DA, Glogowski J, Skipper PL, Wishnok JS, Tannenbaum SR (1982) Analysis of nitrate, nitrite and [15N]nitrate in biological fluids. Anal Biochem 126:131–138

    CAS  PubMed  Google Scholar 

  11. Robins SP, Black D, Paterson CR, Reid DM, Ducan A, Seibel MJ (1991) Evaluation of urinary hydroxypyridinium crosslink measurements as resorption markers in metabolic bone disease. Eur J Clin Invest 21:310–315

    CAS  PubMed  Google Scholar 

  12. Nierman DM, Mechanick JI (1998) Bone hyperresorption is prevalent in chronically critically ill patients. Chest 114:1122–1128

    CAS  PubMed  Google Scholar 

  13. Moncada S, Higgs A (1993) The L-arginine nitric oxide pathway. N Engl J Med 329:2002–2012

    CAS  PubMed  Google Scholar 

  14. Li L, Khansari A, Shapira L, Graves DT, Amar S (2002) Contribution of interleukin-11 and prostaglandin in lipopolysaccharide-induced bone resorption in vivo. Infect Immun 70:3915–3922

    Article  CAS  PubMed  Google Scholar 

  15. Vassalli P (1992) The pathophysiology of tumor necrosis factors. Annu Rev Immunol 10:411–452

    CAS  PubMed  Google Scholar 

  16. Tani T, Hanasawa K, Kodama M, Imaizumi H, Yonekawa M, Saito M, Ikeda T, Yagi Y, Takayama K, Amano I, Shimaoka H, Ohta M, Okahisa T, Koga N, Fujita N, Yamasa H (2001) Correlation between plasma endotoxin, plasma cytokines, and plasminogen activator inhibitor-1 activities in septic patients. World J Surg 25:660–668

    Article  CAS  PubMed  Google Scholar 

  17. Jiang Y, Mehta CK, Hsu TY, Alsulaimani FF (2002) Bacteria induce osteoclastogenesis via an osteoblast-independent pathway. Infect Immun 70:3143–3148

    Article  CAS  PubMed  Google Scholar 

  18. Lind L, Carlstedt F, Rastad J, Stiernstrom H, Stridsberg M, Ljunggren O, Wide L, Larsson A, Hellman P, Ljunghall S (2000) Hypocalcemia and parathyroid hormone secretion in critically ill patients. Crit Care Med 28:93–99

    Article  CAS  PubMed  Google Scholar 

  19. Nakamura T, Ebihara I, Shimada N, Shoji H, Koide H (1998) Modulation of plasma metalloproteinase-9 concentrations and peripheral blood monocyte mRNA levels in patients with septic shock. Effect of fiber-immobilized polymyxin B treatment. Am J Med Sci 316:355–360

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan

    Tsukasa Nakamura, Yasuhiro Kawagoe & Takaharu Matsuda

  2. Department of Medicine, Koto Hospital, 6-8-5 Ojima, Koto-ku, 136-0072, Tokyo, Japan

    Hikaru Koide

Authors
  1. Tsukasa Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuhiro Kawagoe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takaharu Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hikaru Koide
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hikaru Koide.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-004-2357-7

Keywords

Search

Navigation