Kinetics of Different Blood Biomarkers during Polymyxin-B Extracorporeal Hemoperfusion in Abdominal Sepsis

Abstract

Introduction Comparison of the marker kinetics procalcitonin, presepsin and endotoxin during extracorporeal hemoperfusion with polymyxin B adsorbing cartridge (PMX-HA) have never been described in abdominal sepsis. We aim to compare the trend of three biomarkers in septic post-surgical abdominal patients in Intensive care Unit (ICU) treated with PMX-HA and their prognostic value. Methods Ninety abdominal postsurgical patients were enrolled into different groups according to the evidence of postoperative sepsis or not. Non-septic patients admitted in the surgical ward were included in C group (control group). ICU septic shock patients with endotoxin levels <0.6 EAA receiving conventional therapy were addressed in S group and those with endotoxin levels ≥0.6 EAA receiving treatment with PMX-HA, besides conventional therapy, were included in SPB group. Presepsin, procalcitonin, endotoxin and other clinical data were recorded at 24h (T0), 72h (T1) and 7 days (T2) after surgery. Clinical follow-up was performed on day 30. Results SPB group showed reduced levels of the three biomarkers on T2 vs T0 (P<0.001); presepsin, procalcitonin and endotoxin levels decreased respectively of 25%, 11% and 2% on T1 vs T0, and of 40%, 41%, 26% on T2 vs T0. All patients in C group, 73% of patients in SPB group vs 37% of patients in S group survived at follow-up. Moreover, procalcitonin had the highest predictive value for mortality at 30 days, followed by presepsin. Conclusion The present study showed the reliability of presepsin in monitoring PMX-HA treatment in septic shock patients. Procalcitonin showed better predicting power for the mortality risk.