A New Endotoxin Adsorber in Septic Shock: Observational Case Series

Abstract

Aims: Effects of a new endotoxin adsorber on the length of noradrenaline (NA) treatment, LPS (lipopolysaccharide) levels and SOFA (sequential organ failure assessment) scores in septic shock were evaluated. Methods: Two-hour hemoperfusion with LPS adsorber was initiated in patients with septic shock and endotoxemia. Controls were matched for age, focus and severity of illness. Results: Adsorption treatment (n = 9) exhibited a significant decrease in EAA (endotoxin activity assay) activity (0.55 [0.44–0.68] vs. 0.25 [0.13–0.41], p = 0.019) and NA infusion rate (0.217 µg/kg/min [0.119–0.0508] vs. 0 µg/kg/min [0–0.09], p = 0.026) from pretreatment to 24 h post-treatment. The median decrease in SOFA scores from pretreatment to 24 h was 3.0 points (1.5–4.5), p = 0.002. Duration of NA infusion was significantly shorter compared to controls (39 h [31–48] vs. 54 h [43–151], p = 0.03). Conclusions: LPS adsorber treatment was associated with a decrease in NA dose, decrease in SOFA scores and LPS concentrations.

Extracorporeal Blood Purification Therapies for Sepsis

“…The peptide covers the surface of a porous polyethylene matrix designed to provide an optimal binding surface. A few case series in critically ill adults have reported a decrease in endotoxin levels and a hemodynamic improvement [18][19][20]. However, the ASSET (abdominal septic shock -endotoxin adsorption treatment) multicenter RCT evaluating the feasibility of Alteco ® LPS adsorber was terminated early because of patient recruitment issues [21].…”

Biocompatibility and Cytotoxic Evaluation of New Sorbent Cartridges for Blood Hemoperfusion

“…In clinical practice, sorbents have been used to eliminate industrial, pharmacological, or endogenous toxins such as bilirubin or porphyrines [11, 12]. Several new sorbents specifically designed for particular diseases and target molecules to be removed have been proposed in the last years and applied in clinical trials [13-18]. …”

Extracorporeal blood purification for sepsis

“…Clinical experience with this device is scarce, and is limited mainly to case reports and case series. [32][33][34] In general, these case series report a shorter vasopressor infusion duration in adsorber-treated patients compared with controls. Only one underpowered RCT has been published by local investigators.…”