Changes in Plasma Interleukin-18 by Direct Hemoperfusion with Polymyxin B-Immobilized Fiber in Patients with Septic Shock

Abstract

Background/Aims: Polymyxin B-immobilized fiber (PMX-F) treatment is reported to be safe and effective in patients with severe sepsis and septic shock. The aim of the present study was to determine whether plasma levels of interleukin (IL)-18, which is linked with sepsis, are associated with plasma endotoxin levels and sepsis-related scores and whether PMX-F treatment affects these variables in patients with septic shock. Patients and Methods: Twenty-six patients with septic shock (15 men and 11 women; mean age 56.5 years) and 20 age-matched healthy subjects (12 men and 8 women; mean age 54.0 years) were included in this study. Septic shock patients were divided into 2 groups: a PMX-F treatment group (9 men and 5 women; mean age 57.5 years) and a conventional treatment group (7 men and 5 women; mean age 55.3 years). Standard supportive care was continued without change during PMX-F treatment. Plasma endotoxin, plasma IL-18, and clinical variables were measured before, immediately after the first and second PMX-F treatment, and the following day. Results: The plasma IL-18 levels were significantly higher in septic shock patients (1,320 ± 360 pg/ml) than in healthy volunteers (140 ± 60 pg/ml; p < 0.001). The IL-18 level was significantly correlated with the plasma endotoxin level (p < 0.001), the Acute Physiology and Chronic Health Evaluation II score (p < 0.01), the Sepsis Severity Score (p < 0.01), the number of failed organs (p < 0.01), and the Goris score (p < 0.01). PMX-F treatment reduced the plasma endotoxin and IL-18 levels significantly after the first treatment (p < 0.05), after the second treatment (p < 0.01), and on the following day (p < 0.001). However, these variables did not change significantly during conventional treatment. Conclusions: IL-18 may be associated with the severity of septic shock, and PMX-F treatment is effective in reducing the IL-18 level in patients with septic shock.

Direct Hemoperfusion Using Immobilized Polymyxin B in Patients with Rapidly Progressive Interstitial Pneumonias: A Retrospective Study

“…The blood levels of some inflammatory chemokines, e.g. metalloproteinase 9, tissue inhibitor of metalloproteinase 1 [4], neutrophil elastase, IL-8 [46] and IL-18 [47], are immediately decreased in ARDS patients after PMX-DHP. Seo et al [18] have reported that IL-6, IL-8 and plasminogen activator inhibitor 1 are decreased in patients with rapidly progressive IP who responded to PMX-DHP.…”

Hemoperfusion Treatment in a Septic Shock Patient with Autosomal Dominant Polycystic Kidney Disease and Increased HMGB1 Protein Levels

“…PMX is also therapeutic in and of itself: removing endotoxins improves the shock, but does not remove the etiological agents. We and other investigators have reported that PMX-F is effective in reducing various inflammatory mediators in patients with septic shock [16,17,18]. …”

Polymyxin B-immobilized fibre haemoperfusion reduces urinary 8-hydroxy-2'-deoxyguanosine levels in patients with septic shock

“…All blood and urine samples were stored at (808C prior to assay. Blood endotoxin levels were determined by Endospecy test [10,12,13], the normal upper limit being 9.8 pg/ml. Twenty-four hour urine samples obtained starting at 1100h until the next day at 1100h were collected from patients in both groups.…”

“…We have previously reported that PMX-F treatment is effective in reducing various mediators, including serum interleukin-6, interleukin-18, soluble interleukin-2 receptor [12,13]. However, the effect of PMX-F treatment on urinary 8-OHdG levels in septic shock patients is unknown.…”