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Changes in plasma interleukin-18 by direct hemoperfusion with polymyxin B-immobilized fiber in patients with septic
Tsukasa Nakamura1, Yasuhiro Kawagoe, Tsukasa Suzuki
1Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Tokyo, Japan.
Background/Aims:
Polymyxin B-immobilized fiber (PMX-F) treatment is reported to be safe and effective in patients with severe sepsis and septic shock. The aim of the present study was to determine whether plasma levels of interleukin (IL)-18, which is linked with sepsis, are associated with plasma endotoxin levels and sepsis-related scores and whether PMX-F treatment affects these variables in patients with septic shock.
Patients And Methods:
Twenty-six patients with septic shock (15 men and 11 women; mean age 56.5 years) and 20 age-matched healthy subjects (12 men and 8 women; mean age 54.0 years) were included in this study. Septic shock patients were divided into 2 groups: a PMX-F treatment group (9 men and 5 women; mean age 57.5 years) and a conventional treatment group (7 men and 5 women; mean age 55.3 years). Standard supportive care was continued without change during PMX-F treatment. Plasma endotoxin, plasma IL-18, and clinical variables were measured before, immediately after the first and second PMX-F treatment, and the following day.
Results:
The plasma IL-18 levels were significantly higher in septic shock patients (1,320+/- 360 pg/ml) than in healthy volunteers (140+/- 60 pg/ml; p< 0.001). The IL-18 level was significantly correlated with the plasma endotoxin level (p < 0.001), the Acute Physiology and Chronic Health Evaluation II score (p<0.01), the Sepsis Severity Score (p<0.01), the number of failed organs (p<0.01), and the Goris score (p<0.01). PMX-F treatment reduced the plasma endotoxin and IL-18 levels significantly after the first treatment (p<0.05), after the second treatment (p<0.01), and on the following day (p<0.001). However, these variables did not change significantly during conventional treatment.
Conclusions:
IL-18 may be associated with the severity of septic shock, and PMX-F treatment is effective in reducing the IL-18 level in patients with septic shock.
Insights
Polymyxin B-immobilized fiber (PMX-F) treatment effectively reduces interleukin-18 (IL-18) levels in septic shock patients. This reduction correlates with decreased endotoxin levels and improved sepsis severity scores.
Area of Science:
- Critical Care Medicine
- Immunology
- Biomedical Engineering
Background:
- Severe sepsis and septic shock are life-threatening conditions.
- Interleukin-18 (IL-18) is a cytokine implicated in sepsis pathogenesis.
- Polymyxin B-immobilized fiber (PMX-F) is an extracorporeal treatment for sepsis.
Purpose of the Study:
- To investigate the association between plasma IL-18 levels, plasma endotoxin levels, and sepsis severity scores.
- To evaluate the effect of PMX-F treatment on plasma IL-18 and endotoxin levels in septic shock patients.
Main Methods:
- Study included 26 septic shock patients and 20 healthy controls.
- Septic shock patients were divided into PMX-F treatment and conventional treatment groups.
- Plasma endotoxin and IL-18 levels were measured before and after PMX-F treatment.
Main Results:
- Septic shock patients exhibited significantly higher plasma IL-18 levels than healthy controls.
- Plasma IL-18 levels correlated with endotoxin levels and various sepsis severity scores.
- PMX-F treatment significantly reduced plasma endotoxin and IL-18 levels.
Conclusions:
- IL-18 levels are associated with septic shock severity.
- PMX-F treatment demonstrates efficacy in reducing IL-18 levels in septic shock.
