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HEMOPERFUSION USING THE LPS-SELECTIVE MESOPOROUS POLYMERIC ADSORBENT IN SEPTIC SHOCK: A MULTICENTER RANDOMIZED
Sergei Rey1, Vladimir M Kulabukhov1, Alexander Popov2
1N.V. Sklifosovsky Research Institute for Emergency Medicine.
Shock (Augusta, Ga.)
|April 5, 2023
Summary
Extracorporeal hemoperfusion (EHP) with Efferon LPS safely reduced septic shock and improved patient ventilation weaning. This treatment rapidly normalized key biomarkers like lipopolysaccharide (LPS) and cytokines in intra-abdominal sepsis patients.
Area of Science:
- Critical Care Medicine
- Biomedical Engineering
- Infectious Diseases
Background:
- Septic shock poses a significant threat, with treatments aiming to reduce inflammatory mediators like cytokines and bacterial endotoxins (lipopolysaccharide [LPS]).
- Extracorporeal hemoperfusion (EHP) is an emerging therapy that may improve outcomes by directly removing these harmful substances.
Purpose of the Study:
- To evaluate the safety and efficacy of the Efferon LPS hemoperfusion cartridge for treating septic shock in patients with intra-abdominal sepsis (IAS).
- To assess the impact of EHP on hemodynamic parameters, organ function, and key inflammatory biomarkers.
Main Methods:
- A multicenter randomized controlled trial involving 38 patients treated with EHP and 20 control patients receiving conventional care for IAS and septic shock.
- Primary endpoint: resolution of septic shock. Secondary endpoints: MAP, vasopressor dose, oxygenation ratio, SOFA score, ICU length of stay, and biomarker levels (LPS, procalcitonin, CRP, IL-6).
- Statistical analysis included intention-to-treat approach and competing risks analysis for time-to-event data.
Main Results:
- EHP significantly improved mean arterial pressure (MAP), oxygenation, and reduced vasopressor requirements.
- Patients receiving EHP showed faster weaning from mechanical ventilation (subdistribution hazard ratio, 2.5; P = 0.037) and reduced early 3-day mortality.
- Laboratory markers including LPS, procalcitonin, C-reactive protein, IL-6, creatinine, leukocytes, and neutrophils decreased significantly in the EHP group.
Conclusions:
- Efferon LPS EHP is a safe and effective procedure for abrogating septic shock in patients with IAS.
- EHP therapy rapidly normalizes both clinical parameters and pathogenically relevant biomarkers, offering a promising adjunctive treatment strategy.
