Extracorporeal plasma treatment for the removal of endotoxin in patients with sepsis : Clinical results of a pilot study

• Published in: Shock (Augusta, Ga.) Ga.), 2005-06, Vol.23 (6), p.494-500
• Main Authors: BENGSCH, Stefan, BOOS, Karl-Siegfried, NAGEL, Dorothea, SEIDEL, Dietrich, INTHORN, Dietrich
• Format: Article
• Language: English
• Subjects: Adsorption; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; APACHE; Biological and medical sciences; Blood Component Removal; Blood Pressure; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; C-Reactive Protein - metabolism; Cellulose - chemistry; Cholesterol - metabolism; DEAE-Cellulose - chemistry; Emergency and intensive care: infection, septic shock; Endotoxemia - therapy; Endotoxins - metabolism; Escherichia coli - metabolism; Ethanolamines - chemistry; Female; Fibrinogen - metabolism; Humans; Hydrogen-Ion Concentration; Inflammation; Intensive care medicine; Interleukin-6 - blood; Lipopolysaccharides - chemistry; Lipopolysaccharides - metabolism; Male; Medical sciences; Middle Aged; Norepinephrine - pharmacology; Pilot Projects; Plasmapheresis; Prospective Studies; Sepsis - blood; Sepsis - therapy; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 1073-2322; 1540-0514
• DOI: 10.1097/01.shk.0000163803.53978.5c

Despite the advances in therapeutic approaches in the management of inflammatory conditions, the incidence of sepsis is on increase in the intensive care units (ICU). In a pilot study, we investigated whether the use of an apheresis system based on DEAE-cellulose is capable of reducing the plasma concentration of endotoxin in patients with severe sepsis. We enrolled 15 intensive care patients with severe sepsis and plasma endotoxin concentrations >0.3 EU/mL. In addition to standard ICU therapy, a total of 83 apheresis treatments were performed. About 1.7 volumes of plasma (6000 mL) were treated at each apheresis session. A significant reduction in plasma endotoxin levels from a median of 0.61 to 0.39 EU/mL (-35%) could be achieved (P < 0.001). Long-term comparison of the initial and post-treatment levels after a series of five to six individual apheresis treatments also showed a statistically significant decline in circulating endotoxin, interleukin (IL)-6, C-reactive protein (CRP), fibrinogen, and an increase in cholesterol levels. Except for a transient and reversible increase of prothrombin time, no adverse events were observed in patients undergoing this new adsorption apheresis treatment. Our data show that reduction of endotoxin by extracorporeal DEAE-cellulose-based plasma treatment may prove a promising therapeutic tool for patients suffering from bacterial sepsis and proven endotoxemia.