Blood Filter Reduces Mortality in Patients With Sepsis

(Ivanhoe Newswire) – Everyone knows that one of the most dangerous places for a sick person is in the hospital. Patients in intensive care, in particular, are susceptible to severe sepsis and septic shock, which can result in organ dysfunction and even death.

A preliminary study suggests that a therapy for severe sepsis or septic shock, in which the blood is filtered through an external "hemoperfusion" device that has been treated with the antibiotic Polymyxin B to remove toxic products from the blood, in addition to conventional treatment, has resulted in a reduced risk of death.

Severe sepsis and septic shock are common problems in the intensive care unit and carry a high risk of death. Septic shock of intra-abdominal origin is often associated with high endotoxin levels.

"Thus, it represents a condition in which endotoxin-targeted therapy may be of particular benefit," write Dinna N. Cruz, M.D., M.P.H., and Claudio Ronco, M.D., of St. Bortolo Hospital and the International Renal Research Institute Vicenza, Italy, authors of the study.

The randomized controlled trial (RCT) was conducted at ten Italian intensive care units. Patients were randomized to either conventional therapy or to conventional therapy plus two sessions of Polymyxin B hemoperfusion.

"In this RCT of surgical patients with septic shock and severe sepsis induced by abdominal sepsis, Polymyxin B hemoperfusion therapy was effective in improving 28-day survival. Mortality was 32 percent in the Polymyxin B group vs. 53 percent in the conventional therapy group," the authors write.  "We advocate further studies to explore the use of newer assays for endotoxin activity, both for patient selection, as well as guiding the number of hemoperfusion sessions."

In an accompanying editorial, John A. Kellum, M.D., of the University of Pittsburgh, and Shigehiko Uchino, M.D., of the Jikei University School of Medicine, Tokyo, write that the therapy used in this study has been common in Japan for a decade but has not been available in the U.S.

"This kind of cross-community validation is refreshing and necessary, but unfortunately only too rare," the authors wrote. "The results, although preliminary, suggest a number of interesting hypotheses and should provoke further study. This is essential given the significant ongoing problem that sepsis represents."

SOURCE: JAMA,  June 17, 2009

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