Abstract
Objective. To estimate the results of the use of LPS-adsorption in the complex treatment of surgical or obstetric sepsis and septic shock and to determine the risk factors for the development of lethal outcomes.
Materials and methods. Since 2014, twenty-nine patients with surgical or obstetric sepsis and septic shock have been treated at the Perm Regional Clinical Hospital using selective endotoxin adsorption in addition to conventional medical therapy. Endotoxin elimination was performed using hemoperfusion with the Alteco LPS Adsorber (Sweden). The patients were divided into two groups according to the final results of the treatment. The data of clinical and laboratory examinations were compared before and 24 hours after LPS elimination.
Results. Based on the correlation analysis, the most significant risk factors for the development of fatal outcomes are identified. It was found that neither the initial scores on the APACHE, SOFA scale, nor the level of CRP, PCT, EAA have a significant correlation with the lethal outcome. The only indicator before LPS-adsorption that has a direct correlation of the average value with the fatal outcome is the initial dose of norepinephrine. In our study, the mortality rate depends on the decrease in SOFA scores and its components in 24 hours after the procedure. Patients with the lower score after LPS-adsorption would have lower mortality. The predictors of ineffectiveness of treatment, despite the LPS-adsorption, were an unreliable decrease in the dose of vasopressors and the level of PCT, light improvements in the oxygenation index, the presence of bacteremia, septic shock and the delayed procedure.
Conclusion. In surviving patients with surgical sepsis and septic shock, the use of LPS-adsorption in complex treatment significantly improved the function of the cardiovascular and respiratory systems, reduced the level of PCT. The risk factors for the development of lethal outcomes were the initial severity of cardiovascular insufficiency, the selective sorption of endotoxin with a delay, the presence of bacteremia, septic shock, insignificant decrease in SOFA scores and the level of PCT after selective sorption of endotoxin.
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