Anandamide absorption by direct hemoperfusion with polymixin B-immobilized fiber improves the prognosis and organ failure assessment score in patients with sepsis.

Abstract

PURPOSE:

Direct hemoperfusion (DHP) with polymixin B-immobilized fiber (PMX) has been reported to be effective for patients with septic shock. The aim of this study was to clarify the mechanism of PMX-DHP effect on septic shock.

METHODS:

The following parameters were measured in septic shock patients who were treated with PMX-DHP: survival rate, sepsis-related organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE-II) score, and plasma concentrations of cannabinoids [anandamide (ANA) and 2-arachidonyl glyceride (2-AG)], cytokines [interleukin (IL)-6, IL-8, IL-10], transforming growth factor beta (TGF-beta), and calcitonin gene-related peptide (CGRP)]. The primary end point was mortality from all causes at day 28 after intensive care unit (ICU) admission or discharge.

RESULTS:

The survival rate of all patients at 28 days after ICU admission was 37.5% (9/24). The survival group showed significantly lower SOFA and APACHE-II scores than the nonsurvival group after PMX-DHP treatment (P = 0.008 and 0.028, respectively). The improved SOFA score group showed a better survival rate than the nonimproved SOFA score group (71.4% versus 23.5%, P = 0.028). Plasma ANA level significantly decreased after PMX-DHP treatment both in the improved SOFA score group and in the survival group. The level of 2-AG, however, showed no significant change in either group.

CONCLUSION:

ANA, an intrinsic cannabinoid that induces hypotension in septic shock, is inferred to be the main mechanism of the PMX-DHP effect. Removal of ANA by PMX-DHP could be key to successful septic shock treatment.

• Authors: Shinji Kohro, Hitoshi Imaizumi, Michiaki Yamakage, Yoshiki Masuda, Akiyoshi Namiki, Yasuhumi Asai, Ikuo Maruyama
• Journal: Journal of anesthesia (J Anesth) Vol. 20 Issue 1 Pg. 11-6 ( 2006) ISSN: 0913-8668 [Print] Japan
• PMID: 16421670 (Publication Type: Journal Article)

Chemical References

• Arachidonic Acids
• Endocannabinoids
• Polyunsaturated Alkamides
• Transforming Growth Factor beta
• Polymyxin B
• Calcitonin Gene-Related Peptide
• anandamide

Topics

• APACHE
• Adult
• Aged
• Arachidonic Acids (blood, isolation & purification)
• Calcitonin Gene-Related Peptide (blood)
• Endocannabinoids
• Female
• Hemoperfusion (methods)
• Humans
• Male
• Middle Aged
• Multiple Organ Failure (mortality, therapy)
• Polymyxin B (administration & dosage)
• Polyunsaturated Alkamides
• Prognosis
• Prospective Studies
• Shock, Septic (mortality, therapy)
• Survival Rate
• Transforming Growth Factor beta (blood)