Study on Usefulness of Endotoxin Adsorption Therapy (PMX-DHP) for Acute Diffuse Peritonitis accompanying Large Intestinal Perforation

We studied the usefulness of endotoxin adsorption (PMX-DHP) therapy for acute diffuse peritonitis accompanying large intestinal perforation. Subjects comprised 25 patients with intestinal perforation treated with PMX-DHP. The relationships of changes in various clinical indices and mediators such as cytokines to patient survival and therapeutic effects were investigated. Patient survival rate for the 25 subjects was 72.0%. Patient survival rate for severe cases (APACHE-II score≥15) was 61.1%, compared to 21.1% before the introduction of PMX-DHP, indicating a significant improvement in survival for severe cases (p<0.05). Among survivors, systolic blood pressure increased and required dopamine dose could be reduced in most cases after the start of PMX-DHP. However, among the deceased, frequencies of pulmonary, cardiac, hepatic, neurological organ damage and multiple organ damage (affecting≥3 organs), APACHE-II score≥18 and SOFA score≥4 were significantly higher relative to survivors. In subjects with pretherapeutic blood endotoxin (ET) levels≤5 pg/ml, many of cases were survivors. ET levels tended to decrease in survivors after starting PMX-DHP, but to increase in the deceased in ET levels≥5 pg/ml. Levels of interleukin (IL)-6, IL-10 and tissue necrosis factor (TNF)-α in the deceased were higher than those in survivors at all time points, and tended to decrease in survivors after starting PMX-DHP, but to increase in the deceased. Counts of monocytes and monocyte fraction tended to decrease in survivors. The present results demonstrate that PMX-DHP is a useful early therapeutic technique for sepsis caused by large intestinal perforation, and that stabilization of hemodynamics can serve as a clinical indicator for its therapeutic effects. In addition, severity, extent of organ injury and changes in various mediators appear to predict its clinical usefulness.