Selective lipopolysaccharides hemosorption in surgical patients with gram-negative septic shock

Résumé fourni par la source

The objective was to evaluate the clinical efficacy and non-specific adsorption activity of cartridges for selective lipopolysaccharide hemosorption that do not contain immobilized polymyxin in the treatment of surgical patients with gram-negative septic shock (SS). Materials and methods . Forty-three surgical patients with gram-negative SS after debridement surgery were examined. Inclusion criteria: 18–90 years old, procalcitonin (PCT) ≥ 10 ng/ml, sympathomimetic support > 2 hours, normal central venous pressure, no hemo(dia)filtration. In group 1 (30 patients), 1–2 sessions of selective lipopolysaccharide hemosorption (HS) were additionally performed using cartridges that do not contain polymyxin. In group 2 (13 patients), traditional treatment for SS was carried out. HS was carried out for 120 minutes at a rate of 100 ml/min. Hypoagulation was performed with unfractionated heparin or sodium hydrocitrate. Laboratory monitoring: complete blood count, CD14+ monocytes, HLA-DR+ mononuclear cells, Def+ granulocytes, interleukins concentration, PCT, total and C-reactive protein, secretory IgA, fibrinogen, lactate. Results . Patients who survived up to 2 days after surgery were excluded. The final group I with hemoperfusion – 25 patients, group II without hemoperfusion – 11 patients. HS cartridges non-specifically adsorbed 2.6% of erythrocytes, 5.0–14.7% of leukocytes, 25.7% of platelets and 3.8–10.1% of various proteins. The level of cytokines did not change. On the next day, the following levels decreased in group 1: IL-6 from 538 [395; 784] to 290 [200; 726] pg/ml (p = 0.003), IL-8 from 48 [4; 373] to 4 [3; 19] (p = 0.087), PCT from 26.3 [11.1; 53.6] to 14.2 [8.6; 24.5] ng/ml (p = 0.003), platelets from 136 [69; 178] to 89 [50; 142]×109/l (p < 0.001). By days 7–8, in group I, compared to group II, SOFA, APACHE II, and the dose of sympathomimetics decreased. 28-day mortality rate: group I – 32%, group II – 72.7% (p = 0.034). Hospital mortality rate: group I – 56%, group II – 81.8% (p = 0.259). Conclusions . The use of selective lipopolysaccharides hemosorption reduces the severity of multiorgan dysfunctions, systemic inflammation, and mortality. The cartridges adsorb leukocytes, including activated ones. Platelet adsorption reduces their blood count by 25–35%.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.