Hemoperfusion Helps Improve Outcomes for Patients with Severe Sepsis

Bortolo Hospital and the International Renal Research Institute (Vicenza, Italy) conducted a randomized controlled trial in 64 patients with severe sepsis (or septic shock) who underwent emergency surgery for an intra-abdominal infection. The trial wished to determine whether conventional therapy with two supplementary sessions of polymyxin B hemoperfusion (34 patients) would improve clinical outcomes and survival, compared to conventional therapy alone (30 patients); the study was conducted at 10 Italian intensive care units (ICUs). The primary outcome was change in mean arterial pressure (MAP) and vasopressor requirement, and secondary outcomes were fraction of inspired oxygen ratio, change in organ dysfunction (measured using sequential organ failure assessment (SOFA) scores), and 28-day mortality.

The researchers found that polymyxin B hemoperfusion therapy was effective in improving 28-day mortality (32% percent) in the polymyxin B group, compared to 53% mortality in the conventional therapy group. MAP increased and vasopressor requirement decreased at 72 hours in the polymyxin B group, but not in the conventional therapy group. Additionally, the fraction of inspired oxygen ratio increased slightly in the polymyxin B group, but not in the conventional therapy group. The study was published in the June 17, 2009, issue of the Journal of the American Medical Association (JAMA).

"Polymyxin B hemoperfusion added to conventional therapy significantly improved hemodynamics and organ dysfunction and reduced 28-day mortality,” concluded lead author Dinna Cruz, M.D., M.P.H., and colleagues of the department of nephrology, dialysis, and transplantation. "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.”

Polymyxin B is a cationic antibiotic primarily used for resistant gram-negative infections, which works similarly to a detergent, by binding to the cell membrane and altering its structure. This makes the bacteria cell wall more permeable, resulting in water uptake into the bacteria, leading to cell death.

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St. Bortolo Hospital and the International Renal Research Institute