Polymyxin B-immobilized fiber hemoperfusion attenuates increased plasma atrial natriuretic peptide and brain natriuretic peptide levels in patients with septic shock

Polymyxin B-immobilized fiber (PMX-F) hemoperfusion is reported to be safe and effective in septic shock patients. Because atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) may have pathophysiologic significance in the cardiac dysfunction of septic shock patients, we conducted a study to determine whhether PMX-F treatment affects plasma ANP and BNP levels in patients with septic shock. Fifty septic shock patients (34 men and 16 women; mean age 60.0 years) and 30 healthy volunteers (18 men and 12 women; mean age 56.0 years) were included in this study. Polymyxin B-immobilized fiber treatment was performed twice, separated by an interval of 24 hours. Blood endotoxin, interleukin (IL)-6, ANP, and BNP levels were measured before, immediately after the second PMX-F treatment, and the following day. In comparing patients with septic shock with healthy control subjects, we found significant increases in plasma endotoxin (p < 0.001), IL-6 (p < 0.001), ANP (p < 0.001), and BNP (p < 0.001). After the second PMX-F treatment, plasma levels of endotoxin (p < 0.01), IL-6 (p < 0.01), ANP (p < 0.01), and BNP (p < 0.01) were reduced significantly. Values decreased further the following day. Both plasma ANP and BNP levels are increased in septic shock patients and PMX-F treatment is effective in reducing these natriuretic peptide levels.