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Modulation by Polymyxin-B Hemoperfusion of Inflammatory Response Related to Severe Peritonitis

Rémi Coudroy¹, Didier Payen, Yoann Launey

¹*Service de Réanimation Médicale, Hôpital de Poitiers, Poitiers, France †INSERM CIC-P 1402 (ALIVE Group), Université de Poitiers, Poitiers, France ‡Département d'Anesthésie-Réanimation, SAMU, Hôpital Lariboisière, Paris, France §UMR INSERM 116, Université Paris 7 Denis Diderot, Paris, France ||Département d'Anesthésie-Réanimation, Hôpital Pontchaillou, Rennes, France ¶Université de Rennes, Rennes, France #Service de Réanimation, Hôpital de Roanne, Roanne, France **Département d'Anesthésie-Réanimation, Hôpital Charles Nicolle, Rouen, France ††Université de Rouen, Rouen, France ‡‡Département d'Anesthésie-Réanimation, Hôpital civil de Strasbourg, Strasbourg, France §§Université de Strasbourg, Strasbourg, France ||||Département d'Anesthésie-Réanimation, Hôpital Haut-Lévêque, Bordeaux, France ¶¶Université de Bordeaux, Bordeaux, France ##Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France ***Département d'Anesthésie-Réanimation, Centre Hospitalier d'Estaing, Clermont-Ferrand, France †††Université de Clermont-Ferrand, Clermont-Ferrand, France ‡‡‡Département d'Anesthésie-Réanimation, Hôpital de Poitiers, Poitiers, France §§§Université de Poitiers, Poitiers, France ||||||Département d'Anesthésie-Réanimation, Hôpital Trousseau, Tours, France ¶¶¶Université de Tours, Tours, France ###Département d'Anesthésie-Réanimation, Hôpital Huriez, Lille, France ****Université de Lille, Lille, France ††††Service de Réanimation, Hôpital Saint-Jean, Perpignan, France ‡‡‡‡Service de Réanimation Médico-Chirurgicale, Centre Hospitalier de Saint-Malo, Saint-Malo, France §§§§Service de Réanimation Polyvalente, Centre Hospitalier de Lens, Lens, France ||||||||Service d'Immunologie et Inflammation, Hôpital de Poitiers, Poitiers, France ¶¶¶¶EA4331 LITEC, Université de Poitiers, Poitiers, France.

Shock (Augusta, Ga.)

|December 17, 2016

Abstract:

Conflicting results have been reported on the influence of Polymyxin-B hemoperfusion treatment on systemic inflammation markers. The aim of the study was to assess in a randomized control trial the influence on plasma cytokine concentrations of Polymyxin-B hemoperfusion in septic shock due to peritonitis. A panel of 10 pro- or anti-inflammatory cytokines was measured in 213 patients with peritonitis-induced septic shock enrolled in the randomized trial ABDOMIX testing the impact of 2 Polymyxin-B hemoperfusion sessions with standard treatment. Gram-negative bacteria were identified in 69% of patients. In the overall population, baseline plasma cytokine concentrations were not different between the two groups. Circulating tumor necrosis factor-α, interleukin (IL)-1β, IL-10, IL-6, and IL-1RA decreased significantly over time in both groups (P <0.0001 for all in controls, and P = 0.0002, 0.003, and <0.0001 in patients treated with Polymyxin-B hemoperfusion). IL-17A decreased significantly in patients treated with Polymyxin B hemoperfusion (P = 0.045) but not in controls. At the end of the second Polymyxin-B hemoperfusion session or at corresponding time in controls, plasma levels of cytokines did not differ between the two groups. Similar results were found in the subgroup of patients with gram-negative peritonitis who completed two Polymyxin-B hemoperfusion sessions. These results do not support a significant influence of Polymyxin-B hemoperfusion on circulating cytokines assessed except for IL-17A which clinical significance remains to be elucidated.

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