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Effect of polymyxin B-immobilized fiber on bone resorption in patients with sepsis
Tsukasa Nakamura1, Yasuhiro Kawagoe, Takaharu Matsuda
1Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.
Objective:
To analyze the effects of polymyxin B-immobilized fiber (PMX-F) on bone resorption in septic patients.
Design And Setting:
Observational prospective study in intensive care units of a general hospital.
Patients And Participants:
25 patients with severe sepsis and 20 healthy controls.
Measurements And Results:
Septic patients were randomly assigned to two groups: PMX-F treatment group (n=15) and conventional treatment group (n=10). Total pyridinium crosslink pyridinoline (PYD) and deoxypyridinoline (DPD) in urine were determined by modified high-performance liquid chromatography. Nitric oxide production was assessed by measuring the ratio of the nitric oxide breakdown products to urinary creatinine (NOx/Cr). Plasma endotoxin levels were determined by endospecy test. The blood albumin, ionized calcium, and parathyroid hormone were also measured. PMX-F treatment was performed twice separated by 24 h. Urinary NOx/Cr, PYD/Cr, and DPD/Cr were significantly increased in septic patients compared with those in healthy controls. Blood ionized calcium in septic patients was lower than in healthy controls, while parathyroid hormone levels in septic patients were higher than in healthy controls (P<0.01). PMX-F treatment reduced plasma endotoxin, urinary NOx/Cr, PYD/Cr, DPD/Cr, and serum parathyroid hormone levels and increased blood ionized calcium significantly; however, conventional treatment did not affect these levels.
Conclusions:
Septic patients increased nitric oxide production and bone resorption, and PMX-F treatment is effective in reducing nitric oxide levels and bone resorption markers.