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Use a Novel Hemoperfusion Cartridge Efferon LPS for Simultaneous Adsorption of Cytokines and Endotoxin in Septic Shock: A Case Report

Received: 27 July 2021     Accepted: 17 August 2021     Published: 27 August 2021
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Abstract

A patient (age 75, male) with diffuse peritonitis (cecum rupture resulted from tumor obturation) was hospitalized and underwent emergency surgery. He was hypotensive (norepinephrine 0.56 mg/kg*min) and exhibited multiple organ failure syndrome (SOFA=10), so a septic shock diagnosis was concluded. Standard of care treatment didn’t result in improvement of his condition and so he was subjected to extracorporeal hemoperfusion with Efferon LPS adsorber. Efferon LPS is single-use therapeutic device, certified in Russia, a cartridge with selective adsorbent polymeric beads, which provide simultaneous lipopolysaccharide (LPS) and cytokines adsorption (“multimodal” action). Two conclusive hemoperfusions led to quick improvements in hemodynamic parameters and improvement of patient’s condition. IL-6 serum level dropped from 1640 to 480 pG/mL, followed by subsequent decrease down to 350 pG/mL within next few days. Procalcitonin levels dropped from 98 nG/mL down to 5 nG/mL. Significant decrease in CD14+ blood monocytes also was noted during each hemoperfusion session. The patient stayed in ICU for 8 days. He has survived and was discharged on day 24 in satisfactory condition. Extracorporeal sequestration of LPS, cytokines and which is extremely important CD14+ monocytes from the bloodstream can dampen the systemic inflammation’s crippling action in patients with sepsis. Efferon LPS hemoperfusion is prominent option for extracorporeal treatment of septic shock.

Published in World Journal of Medical Case Reports (Volume 2, Issue 3)
DOI 10.11648/j.wjmcr.20210203.14
Page(s) 46-50
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

LPS-selective Hemoperfusion, Anti-cytokine Hemoperfusion, Sepsis, Septic Shock, СD14+ Monocytes, Procalcitonin, IL-6

References
[1] Esteban E., Ferrer R., Alsina L., Artigas A. Immunomodulation in sepsis: the role of endotoxin removal by polymyxin B-immobilized cartridge. Mediators Inflamm. 2013, Oct 22. doi: 10.1155/2013/507539.
[2] Honore P. M., Hoste E., Molnár Z. et al. Cytokine removal in human septic shock: where are we and where are we going? Ann. Intensive Care. 2019; 9: 56. doi: 10.1186/s13613-019-0530-y.
[3] Zhou F., Peng Z., Murugan R., Kellum J. A. Blood purification and mortality in sepsis: a meta-analysis of randomized trials. Crit. Care Med. 2013; 41 (9): 2209-2220. doi: 10.1097/CCM.0b013e31828cf412.
[4] Goetz G., Hawlik K., Wild C. Extracorporeal cytokine adsorption therapy as a preventive measure in cardiac surgery and as a therapeutic add-on treatment in sepsis: an update systematic review of comparative efficacy and safety. Crit Care Med. 2021, May 3. doi: 10.1097/CCM.0000000000005023.
[5] Paul R., Sathe P., Kumar S. et al. Multicentered prospective investigator initiated study to evaluate the clinical outcomes with extracorporeal cytokine adsorption device (CytoSorb®) in patients with sepsis and septic shock. World J Crit Care Med. 2021; 10 (1): 22-34. doi: 10.5492/wjccm.v10.i1.22.
[6] Gleason T. G., Argenziano M., Bavaria J. E. et al. Hemoadsorption to reduce plasma free hemoglobin during cardiac surgery: results of REFRESH I pilot study. Semin Thorac Cardiovasc Surg. 2019; 31 (4): 783-793. doi: 10.1053/j.semtcvs.2019.05.006.
[7] Asch S., Kaufmann T., Walter M. et al. The effect of perioperative hemadsorption in patients operated for acute infective endocarditis – a randomized, controlled study. Artif Organs. 2021, Jun 21. doi: 10.1111/aor.14019.
[8] Ushakova N. D., Tikhonova S. N., Rozenko D. A. Hemosorption by a column adsorber based on hyper-cross-linked styrene-divinylbenzene copolymer with immobilized lipopolysaccharide-selective ligand in combined intensive care of lung cancer-related postoperative acute lung injury (Case report). General Reanimatology. 2020; 6 (4): 14-20. doi.org/10.15360/1813-9779-2020-4-14-20. [Rus]
[9] Magomedov M. A., Kim T. G., Masolitin S. V. et al. Use of sorbent based on hypercrosslinked styrene-divinylbenzene copolymer with immobilized LPS-selective ligand in hemoperfusion for treatment of patients with septic shock. General Reanimatology. 2020; 16 (6): 31-53. doi: 10.15360/1813-9779-2020-6-31-53. [Rus]
[10] Vincent J. L., Moreno R., Takala J. et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/falure. On behalf of the Working Group on Sepsis-related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996; 22: 707-710.
[11] Ziegler-Heitbrock L. The CD14+CD16+ blood monocytes: their role in infection and inflammation. J Leukoc Biol. 2007; 81 (3): 584-592. doi: 10.1189/jlb.0806510.
[12] Kapellos T. S., Bonaguro L., Gemünd I. et al. Human monocyte subsets and phenotypes in major chronic inflammatory diseases. Front. Immunol. 2019, Aug 30. doi: 10.3389/fimmu.2019.02035.
[13] Tsujimoto Н., Ono S., Hiraki Sh. Hemoperfusion with polymyxin B-immobilized fibers reduced the number of CD16+CD14+ monocytes in patients with septic shock. Journal of Endotoxin Research. 2004; 10: 229-237.
[14] Nishiboria M., Takahashia H. K., Katayamab H. et al. Specific removal of monocytes from peripheral blood of septic patients by Polymyxin B-immobilized filter column. Acta Med. Okayama. 2009; 63 (1): 65-69.
[15] Kumagai T., Takeyama N., Yabuki T. et al. Apheresis of activated leukocytes with an immobilized polymyxin filter in patient with septic shock. Shock. 2010; 34 (5): 461-466.
[16] Morozov A. S., Kopitsyna M. N., Bessonov I. V. et al. // A selective sorbent for removing bacterial endotoxins from blood. Russian Journal of Physical Chemistry A. 2016; 90 (12): 2465-2470. [Rus]
[17] WO2018217137 A1 Bessonov I. V., Morozov A. S., Kopitsyna M. N. A polymeric sorbent, preparation and use thereof, available 2018-11-29.
[18] David S. A. Towards a rational development of anti-endotoxin agents: novel approaches to sequestration of bacterial endotoxins with small molecules. J Molecular Recognition. 2001; 14 (6): 370-387. doi: 10.1002/jmr.549.
Cite This Article
  • APA Style

    Mikhail Ivanovich Gromov, Ludmila Pavlovna Pivovarova, Irina Viktorovna Osipova, Olga Borisovna Ariskina, Alexey Valerievich Fedorov. (2021). Use a Novel Hemoperfusion Cartridge Efferon LPS for Simultaneous Adsorption of Cytokines and Endotoxin in Septic Shock: A Case Report. World Journal of Medical Case Reports, 2(3), 46-50. https://doi.org/10.11648/j.wjmcr.20210203.14

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    ACS Style

    Mikhail Ivanovich Gromov; Ludmila Pavlovna Pivovarova; Irina Viktorovna Osipova; Olga Borisovna Ariskina; Alexey Valerievich Fedorov. Use a Novel Hemoperfusion Cartridge Efferon LPS for Simultaneous Adsorption of Cytokines and Endotoxin in Septic Shock: A Case Report. World J. Med. Case Rep. 2021, 2(3), 46-50. doi: 10.11648/j.wjmcr.20210203.14

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    AMA Style

    Mikhail Ivanovich Gromov, Ludmila Pavlovna Pivovarova, Irina Viktorovna Osipova, Olga Borisovna Ariskina, Alexey Valerievich Fedorov. Use a Novel Hemoperfusion Cartridge Efferon LPS for Simultaneous Adsorption of Cytokines and Endotoxin in Septic Shock: A Case Report. World J Med Case Rep. 2021;2(3):46-50. doi: 10.11648/j.wjmcr.20210203.14

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  • @article{10.11648/j.wjmcr.20210203.14,
      author = {Mikhail Ivanovich Gromov and Ludmila Pavlovna Pivovarova and Irina Viktorovna Osipova and Olga Borisovna Ariskina and Alexey Valerievich Fedorov},
      title = {Use a Novel Hemoperfusion Cartridge Efferon LPS for Simultaneous Adsorption of Cytokines and Endotoxin in Septic Shock: A Case Report},
      journal = {World Journal of Medical Case Reports},
      volume = {2},
      number = {3},
      pages = {46-50},
      doi = {10.11648/j.wjmcr.20210203.14},
      url = {https://doi.org/10.11648/j.wjmcr.20210203.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjmcr.20210203.14},
      abstract = {A patient (age 75, male) with diffuse peritonitis (cecum rupture resulted from tumor obturation) was hospitalized and underwent emergency surgery. He was hypotensive (norepinephrine 0.56 mg/kg*min) and exhibited multiple organ failure syndrome (SOFA=10), so a septic shock diagnosis was concluded. Standard of care treatment didn’t result in improvement of his condition and so he was subjected to extracorporeal hemoperfusion with Efferon LPS adsorber. Efferon LPS is single-use therapeutic device, certified in Russia, a cartridge with selective adsorbent polymeric beads, which provide simultaneous lipopolysaccharide (LPS) and cytokines adsorption (“multimodal” action). Two conclusive hemoperfusions led to quick improvements in hemodynamic parameters and improvement of patient’s condition. IL-6 serum level dropped from 1640 to 480 pG/mL, followed by subsequent decrease down to 350 pG/mL within next few days. Procalcitonin levels dropped from 98 nG/mL down to 5 nG/mL. Significant decrease in CD14+ blood monocytes also was noted during each hemoperfusion session. The patient stayed in ICU for 8 days. He has survived and was discharged on day 24 in satisfactory condition. Extracorporeal sequestration of LPS, cytokines and which is extremely important CD14+ monocytes from the bloodstream can dampen the systemic inflammation’s crippling action in patients with sepsis. Efferon LPS hemoperfusion is prominent option for extracorporeal treatment of septic shock.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Use a Novel Hemoperfusion Cartridge Efferon LPS for Simultaneous Adsorption of Cytokines and Endotoxin in Septic Shock: A Case Report
    AU  - Mikhail Ivanovich Gromov
    AU  - Ludmila Pavlovna Pivovarova
    AU  - Irina Viktorovna Osipova
    AU  - Olga Borisovna Ariskina
    AU  - Alexey Valerievich Fedorov
    Y1  - 2021/08/27
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    T2  - World Journal of Medical Case Reports
    JF  - World Journal of Medical Case Reports
    JO  - World Journal of Medical Case Reports
    SP  - 46
    EP  - 50
    PB  - Science Publishing Group
    SN  - 2994-726X
    UR  - https://doi.org/10.11648/j.wjmcr.20210203.14
    AB  - A patient (age 75, male) with diffuse peritonitis (cecum rupture resulted from tumor obturation) was hospitalized and underwent emergency surgery. He was hypotensive (norepinephrine 0.56 mg/kg*min) and exhibited multiple organ failure syndrome (SOFA=10), so a septic shock diagnosis was concluded. Standard of care treatment didn’t result in improvement of his condition and so he was subjected to extracorporeal hemoperfusion with Efferon LPS adsorber. Efferon LPS is single-use therapeutic device, certified in Russia, a cartridge with selective adsorbent polymeric beads, which provide simultaneous lipopolysaccharide (LPS) and cytokines adsorption (“multimodal” action). Two conclusive hemoperfusions led to quick improvements in hemodynamic parameters and improvement of patient’s condition. IL-6 serum level dropped from 1640 to 480 pG/mL, followed by subsequent decrease down to 350 pG/mL within next few days. Procalcitonin levels dropped from 98 nG/mL down to 5 nG/mL. Significant decrease in CD14+ blood monocytes also was noted during each hemoperfusion session. The patient stayed in ICU for 8 days. He has survived and was discharged on day 24 in satisfactory condition. Extracorporeal sequestration of LPS, cytokines and which is extremely important CD14+ monocytes from the bloodstream can dampen the systemic inflammation’s crippling action in patients with sepsis. Efferon LPS hemoperfusion is prominent option for extracorporeal treatment of septic shock.
    VL  - 2
    IS  - 3
    ER  - 

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Author Information
  • Department of Efferent Therapy, Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, Saint-Petersburg, Russia

  • Laboratory Diagnostics Department, Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, Saint-Petersburg, Russia

  • Laboratory Diagnostics Department, Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, Saint-Petersburg, Russia

  • Laboratory Diagnostics Department, Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, Saint-Petersburg, Russia

  • Department of Efferent Therapy, Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, Saint-Petersburg, Russia

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