In:
Therapeutic Apheresis and Dialysis, Wiley, Vol. 17, No. 5 ( 2013-10), p. 472-476
Abstract:
Disseminated intravascular coagulation ( DIC ) and multiple organ failure often occur via the crosstalk between inflammation and coagulation, which is mediated by H igh M obility G roup B ox 1 ( HMGB 1). In septic shock, P olymyxin‐ B direct hemoperfusion ( PMX‐DHP ) ameliorates hemodynamics by endogenous cannabinoid adsorption and improves pulmonary oxygenation by indirect cytokine reduction through the adsorption of activated mononuclear cells. However, PMX‐DHP has no direct effect on HMGB 1 circulating in the plasma. In cases with DIC , recombinant thrombomodulin ( rTM ), an effective drug for DIC , exerts not only anticoagulation but also antiinflammatory properties via direct anti‐ HMGB 1 activity. Therefore, a combination of PMX‐DHP and rTM is expected to block the vicious cycle of a cytokine storm ending up with multiple organ failure in DIC . The aim of this study was to investigate the efficacy of combination therapy for septic shock associated with DIC . This study comprised 22 consecutive patients with sepsis‐induced DIC who received PMX‐DHP . The initial eight patients were treated without rTM (historical control group), and the following 14 patients were given rTM ( rTM group). The baseline S equential O rgan F ailure A ssessment ( SOFA ) score or age was not different between both groups. Sixty‐day survival rate in the rTM group was significantly higher than that in the control group (85.7% vs. 37.5%, P = 0.015). A combination of PMX‐DHP and rTM may be effective in septic shock accompanied by DIC and is expected to improve survival rates.
Type of Medium:
Online Resource
ISSN:
1744-9979
,
1744-9987
DOI:
10.1111/tap.2013.17.issue-5
DOI:
10.1111/1744-9987.12112
Language:
English
Publisher:
Wiley
Publication Date:
2013
detail.hit.zdb_id:
2010864-3
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