Document Detail


Urinary liver-type fatty acid-binding protein in septic shock: effect of polymyxin B-immobilized fiber hemoperfusion.
MedLine Citation:
PMID:  18838948     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We aimed to determine retrospectively whether urinary liver-type fatty acid-binding protein (L-FABP) levels are altered in patients with septic shock or severe sepsis without shock and whether polymyxin B-immobilized fiber (PMX-F) hemoperfusion affects these levels. Forty patients with septic shock, 20 patients with severe sepsis without shock, 20 acute renal failure (ARF) patients without septic shock (mean serum creatinine, 2.8 mg/dL), and 30 healthy volunteers were included in this study. Polymyxin B-immobilized fiber hemoperfusion was performed twice in 40 patients. In addition, 10 patients with septic shock without PMX-F treatment (conventional treatment) were also enrolled in this study. Their families did not choose PMX-F treatment. Thus, their informed consents to perform PMX-F treatment were not obtained. Septic shock or severe sepsis was defined by the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. Patients with septic shock were eligible for inclusion in the study if they had a definable source of infection and/or positive blood cultures. Patients with cardiogenic or hemorrhagic shock were excluded from the study. The patients were not randomly allocated to receive PMX-F treatment. Urinary and serum L-FABP levels were measured by enzyme-linked immunosorbent assay method. Plasma endotoxin levels in patients with septic shock were significantly higher than those in patients with severe sepsis (P < 0.05), patients with ARF (P < 0.001), and healthy subjects (P < 0.001). Urinary L-FABP levels in patients with septic shock were significantly higher than those in patients with severe sepsis without shock (P < 0.001), patients with ARF (P < 0.001), and healthy subjects (P < 0.001), whereas serum L-FABP levels showed no significant differences between patients with septic shock, patients with severe sepsis, patients with ARF, and healthy subjects. Urinary L-FABP was not correlated with serum L-FABP. Twenty-eight patients with septic shock survived, and 12 patients died. Polymyxin B-immobilized fiber treatment reduced plasma endotoxin levels (P < 0.01) and urinary L-FABP levels (P < 0.01). In 10 patients with septic shock without PMX-F treatment, L-FABP levels remained high 7 days after initiation of conventional treatment (P = 0.12). These results suggest that urinary L-FABP levels are significantly increased in patients with septic shock and that PMX-F treatment is effective in reducing these levels.
Authors:
Tsukasa Nakamura; Takeshi Sugaya; Hikaru Koide
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  31     ISSN:  1540-0514     ISO Abbreviation:  Shock     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-14     Completed Date:  2009-06-29     Revised Date:  2009-08-02    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  United States    
Other Details:
Languages:  eng     Pagination:  454-9     Citation Subset:  IM    
Affiliation:
Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anti-Bacterial Agents / administration & dosage,  therapeutic use*
Endotoxins / blood
Enzyme-Linked Immunosorbent Assay
Fatty Acid-Binding Proteins / blood*,  urine*
Female
Hemodynamics
Hemoperfusion* / methods
Humans
Male
Middle Aged
Polymyxin B / administration & dosage,  therapeutic use*
Retrospective Studies
Sepsis / blood,  urine
Shock, Septic / blood,  drug therapy*,  urine
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Endotoxins; 0/Fatty Acid-Binding Proteins; 1404-26-8/Polymyxin B

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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