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A study of high mobility group 1 parameters in septic disseminated intravascular coagulation treated by direct hemoperfusion with immobilized polymyxin B fibers
Gaku Takahashi, Shigeatsu Endo and Yoshihiro Inoue
Background: High mobility group 1 (HMGB1) is a proinflammatory cytokine that acts as a terminal mediator of endotoxin-phase. HMGB1 also increases tissue factor expression in human peripheral blood monocytes and induces DIC. We investigated HMGB1 values when polymyxin B-immobilized fiber (PMXDHP) hemoperfusion was performed to treat patients with septic DIC with endotoxemia.
Methods: Serum high-mobility endotoxin group 1 (HMGB1) levels were investigated in 16 patients with septic disseminated intravascular coagulation (DIC) who underwent direct hemoperfusion with immobilized polymyxin B fibers (PMXDHP), had serum endotoxin levels ≥ 1.1 pg/mL, and presented with symptoms of shock.
Results: The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 32.2, the mean Sequential Organ Failure Assessment (SOFA) score was 12.4, and the mean DIC score was 5.5. After PMX-DHP, the serum endotoxin level decreased below the detection limit in all patients. The serum HMGB1 level significantly decreased and the DIC score improved at days 1 and 2 after PMX-DHP (P < 0.05). There was a significant correlation between HMGB1 values and DIC score (P < 0.05).
Conclusions: PMX-DHP was found to be an effective treatment for septic DIC and HMGB1 was found to be a useful index for this clinical condition.