The Clinical Significance of Serum Procalcitonin Levels following Direct Hemoperfusion with Polymyxin B-Immobilized Fiber Column in Septic Patients with Colorectal Perforation

Abstract

Background: The efficacy of direct hemoperfusion with polymyxin B-immobilized fiber columns (PMX) has already been demonstrated in clinical studies for the treatment of septic shock. However, serum procalcitonin levels following PMX remain unknown. Methods: This prospective, multicenter, nonrandomized clinical study was performed at 12 institutions. Forty-five patients with severe sepsis or septic shock due to colorectal perforation underwent PMX. Patients’ outcome as well as circulating levels of endotoxin, procalcitonin and IL-6 were monitored. Results: Before surgery, procalcitonin level, but not endotoxin and IL-6 levels, was elevated according to patients’ septic conditions. Procalcitonin was significantly and positively correlated with sequential organ failure assessment score. Circulating levels of procalcitonin peaked 24 h after PMX treatment. Change in serum procalcitonin level was significantly higher in nonsurvivors than survivors. Nine mortalities were observed within 28 days. The best predictor for 28-day mortality was procalcitonin >85.7 ng/ml at 24 h after PMX (area under the receiver operating characteristic curve: 0.808 ± 0.105). Conclusions: Procalcitonin may be a good indicator of severity of sepsis secondary to colorectal perforation. Furthermore, procalcitonin level at 24 h after PMX appears to predict outcome after PMX. Therefore, procalcitonin may be a useful diagnostic marker to evaluate patients’ condition in candidates for PMX treatment.

Clinical effects of polymyxin B‐immobilized fiber column direct hemoperfusion for severe bacterial meningitis: A series of 10 cases

“…When this inflammation spreads to the brain parenchyma and cerebral blood vessels, it causes cerebral edema, increased intracranial pressure, cerebrovascular disability, cerebral vasculitis, and neuronal damage, which leads to poor outcomes such as neurological sequelae and death . PMX‐DHP may suppress inflammation by absorbing activated leukocytes and LTA and reducing pro‐inflammatory cytokines . Eight of our 10 patients were identified to have Gram‐positive bacteria, which do not have lipopolysaccharide.…”

The Elevation in Preoperative Procalcitonin Is Associated with a Poor Prognosis for Patients Undergoing Resection for Colorectal Cancer

“…Timing of blood sampling is basically in the day before surgery or before induction of anesthesia. PCT was measured by Elecsys® Brahms PCT and Cobas 8000® (Roche Diagnostics Corporation, Tokyo, Japan; range 0.05–100 ng/mL) [11]. The mGPS and PNI were evaluated as previously described [5, 6].…”

Successful treatments with polymyxin B hemoperfusion and recombinant human thrombomodulin for fulminant Clostridium difficile-associated colitis with septic shock and disseminated intravascular coagulation: a case report

“…First, fulminant CDAC with MODS is caused by the shift from an inflammatory response at a local mucosal level to a general systemic inflammatory reaction in which CD toxin-induced mediators’ cascades disseminate [ 30 – 36 ]. Second, although PMX-HP removes circulating endotoxin by adsorption and theoretically prevents the progression of the biological cascade of sepsis, several studies and published reports have demonstrated that PMX-HP can reduce the plasma levels of cytokines and sepsis-related factors, namely TNF-α, IL-6, IL-10, N -arachidonoylethanolamine (AEA), 2-arachidonoyl glycerol (2-AG), and high-mobility group box-1 (HMGB-1) [ 21 , 23 , 38 , 39 ]. Indeed, there were case reports published which showed that PMX-HP decreases the serum levels of endogenous cannabinoids (anandamide and 2-AG) and inflammatory cytokine (IL-6) in parallel with the clinical improvement of fulminant CDAC [ 40 , 41 ].…”