Treatment with polymyxin B-immobilized fiber reduces platelet activation in septic shock patients:: Decrease in plasma levels of soluble P-selectin, platelet factor 4 and β-thromboglobulin

Objective: To clarify whether plasma concentrations of soluble P-selectin, platelet faotor-4, (PF-4) and beta-thromboglobulin (beta TG) are altered in patients with septic shock and whether polymyxin B-immobilized fiber (PMX-F) treatment affects these changes. Subjects: Thirty patients with septic shock who were treated with PMX-F (group A), 20 such patients who received conventional therapies (group B) and 20 healthy control subjects(group C), Methods: ELISA using commercial kits. Endotoxin elimination by direct hemoperfusion using PMX-F. Results: Blood endotoxin levels decreased significantly from 49.4+/-8.8 pg/ml to 13.0 +/- 4.5 pg/ml after PMX-F treatment. The pretreatment plasma concentrations of soluble P-selectin, PF-4 and beta TG in patients in groups A and B were significantly higher than those in group C (p < 0.001). Plasma concentrations of these factors decreased significantly in group A after PMX-F treatment (p < 0.01); however, the concentrations in group B were not altered after conventional treatment. The survival rate of group A (60%) was higher than that of group B (30%). Conclusions: Our findings suggest that soluble P-selectin, PF-4 and beta TG may be associated with septic shock and that PMX-F is effective in reducing these markers in patients with septic shock.