The use of lipopolysaccharide adsorption employing advanced domestically manufactured cartridges in the comprehensive treatment of maternal sepsis and septic shock

Objective. To estimate the results of lipopolysaccharide adsorption using a domestic Efferon LPS cartridge in the complex treatment of maternal sepsis and septic shock. Materials and methods. In Perm Regional Clinical Hospital, a comprehensive treatment of 22 patients with maternal sepsis or septic shock was carried out using LPS adsorption with domestic Efferon LPS columns in Perm Regional Clinical Hospital. The results of clinical and laboratory examination were compared before extracorporeal selective adsorption of endotoxin and in 24, 48 and 72 hours. The APACHE and SOFA scales were used. The level of inflammation biomarkers and endotoxin activity were determined. Results. After LPS adsorption, the median SOFA score decreased significantly to 5 (p = 0.00). A distinct decline was observed in the levels of creatinine, lactate dehydrogenase, procalcitonin, interleukins 1b, 8, 10, a tendency to decrease in the amount of C-reactive protein, presepsin, interleukin 6, tumor necrosis factor and endotoxin activity. The maximum effect of LPS adsorption using Efferon LPS columns occurred after the first session. After the second procedure, the severity on SOFA scale, endotoxin activity, procalcitonin and lactate levels decreased insignificantly. In 72 hours, the amount of procalcitonin and lactate tended to increase again. The hospital 28-day mortality rate was 22.73 %. The fatal outcomes correlated with the patients` initial condition. The higher the scores on the APACHE, SOFA scales, the Charlson index, the initial dose of norepinephrine (r = 0.38, p = 0.00; r = 0.37, p = 0.00; r = 0.34, p = 0.00; r = 0.43, p = 0.02, respectively) were, the worse was the result of the comprehensive treatment for maternal sepsis. Improvement of the clinical condition on the SOFA scale, an oxygenation index, and a decrease in vasopressors dose (r = 0.71, p = 0.00; r = -0.54, p = 0.00; r = 0.61, p = 0.00, respectively), as well as the results of laboratory studies (lactate – r = 0.58, p = 0.00; EAA – r = 0.57, p = 0.00; PCT – r = 0.59, p = 0.00) had a medium or strong correlation with the patients` recovery. Conclusions. The inclusion of lipopolysaccharide adsorption with domestic Efferon LPS columns in the comprehensive treatment for maternal sepsis and septic shock makes it possible to achieve a significant improvement in the patients` clinical condition, reduce the level of inflammation biomarkers, endotoxin activity and interleukins.