Removal of Humoral Mediators and the Effect on the Survival of Septic Patients by Hemoperfusion With Neutral Microporous Resin Column

Abstract

The aim of this study is to evaluate the impact of neutral microporous resin hemoperfusion on hemodynamic improvement, removal of inflammatory cytokines, and mortality in critical care patients with severe sepsis. Forty-four patients with severe sepsis or septic shock were randomized to HA type hemoperfusion treatment (N=24) or standard therapy (N=20). Those undergoing hemoperfusion treatment received HA330 hemoperfusion. We measured the plasma concentrations of IL-6 and IL-8 at the start of every hemoperfusion treatment, and the following parameters were compared between the control group and the hemoperfusion group on days 3, 7, and 14: hemodynamics (cardiac index, systemic vascular resistance index, heart rate, and mean arterial pressure); change of hematology and coagulation function; organ function; and the sequential organ failure assessment (SOFA) score. Hospital, 28-day, and ICU mortality were also observed. Patients treated with HA hemoperfusion showed a significant removal of plasma IL-6 and IL-8 over time while in the study. Patients in the HA group also demonstrated significant increases in cardiac index, systemic vascular resistant index, fast withdrawal of vasoactive agents and decreases in heart rate compared with the controls at days 3 and 7. Although there was no significant difference between the groups in organ dysfunction as assessed by SOFA scores from day 0 (baseline) to day 7, significant improvement can be demonstrated in the hemoperfusion group at day 14. There was no significant difference between the groups in 28-day mortality, hospital mortality, or length of hospital stay, but ICU mortality and the length of ICU stay in the HA group were markedly reduced. Hemoperfusion treatment using the HA type cartridge in sepsis is safe and it may improve organ dysfunction, ICU mortality, and shorten the length of ICU stay. Clinical significant removal of inflammatory cytokines such as IL-6 and IL-8 from circulation by hemoperfusion may contribute to improving a patient's outcome in an ICU.

Biocompatibility and Cytotoxic Evaluation of New Sorbent Cartridges for Blood Hemoperfusion

“…To date, they have been thoroughly studied and widely used in China with no reported safety concerns [31-37]. Important to note that, apart from a few incidents of fever described by the studies of Huang et al [33] and Hu et al [35], no clinically significant side effects including symptoms and laboratory findings suggestive of bio-incompatibility were reported in these studies. Drop in platelet count was noted but was often transient, described as not clinically significant, and not resulting in bleeding events or requirement of blood transfusion.…”

Fluid Dynamics Analysis by CT Imaging Technique of New Sorbent Cartridges for Extracorporeal Therapies

“…A previous study carried out by our research group has demonstrated the biocompatibility, in terms of cytotoxicity, of the housing and the beads material [13]. HA cartridges are among the widely studied and used in China: several trials have been conducted and confirmed their reliability in clinical application [14][15][16], as reported in a recent review [12].…”

Combined use of non-biological artificial liver treatments for patients with acute liver failure complicated by multiple organ dysfunction syndrome

“…Hemsoperfuion using HA resin perfusion, a neutral macroporous resin adsorption 500-5 000 Da major molecular weight substance, can absorb a variety of proteins binding toxins and cytotoxic substances, which inhibit regeneration of liver. [10] CVVH can continually eliminate the molecular substances, ammonia and other toxic substances such as false neurotransmitters, free fatty acids, amino acids, aromatic thiols in patients with acute liver failure, increase the content of CAMP in cerebrospinal fluid, improve energy metabolism in the brain, alleviate and ameliorate hepatic encephalopathy. CVVH can accurately control capacity, continuously and slowly remove the solute and liquid, regulate water, electrolyte and acid-base balance, and reduce the occurrence of brain edema in patients with acute liver failure.…”