Sepsis is a potentially life-threatening condition when the body's response to an infection damages its tissues. It may progress to septic shock, a dramatic drop in blood pressure that can lead to severe organ problems and death.[1] Sepsis and septic shock are major causes of ICU admission worldwide.

Despite recent advances in treatment, ICU patients with septic shock mortality remain steadily high. Especially in those requiring a high dosage of vasopressors, whose 28-day mortality rate could reach 60%. According to a report posted by the WHO, sepsis kills 11 million people each year and disables millions more. [2]  

But do we have proper treatment for it? Hemoperfusion is emerging as an important potential therapy. Here is the case that can tell.

Case Review

A 56-year-old male patient from Chuong Xa - Cam Khe, Vietnam, was sent to the Emergency Department of Phu Tho Provincial General Hospital on April 25, 2022, in a state of fever diarrhea, low blood pressure, and respiratory distress. Even worse, he has a background of kidney failure, diabetes, and hepatic cirrhosis.

The patient before applying hemoperfusion therapy

After being diagnosed with septic shock caused by abdominal and GI tract infections, he was treated with antibiotics, mechanical ventilation, and Jafron’s HA330 applied on the JF-800A hemoperfusion machine.

Luckily, he discontinued vasopressors and was extubated after a single hemoperfusion treatment. On top of that, his fever and blood pressure were brought down and stabilized. The treatment results of the tested parameters of 0 - 12h - 24h - 48h on clinically relevant outcomes are in the Table. In the two-day treatment, APACHE II score, CRP, and Procalcitonin (PCT) showed a significant drop, from 19 to 8, 161 to 30, and 34 to 5, respectively. And finally, he was discharged on the fourth day after being sent to the hospital.

The patient after applying a first hemoperfusion

Conclusion

In the above case, Jafron's HA330 and JF-800A demonstrate outstanding potential in the patient's rapid recovery. Based on the pathophysiology, hemoperfusion is a potential treatment for septic shock. It is an extracorporeal blood purification therapy that allows whole blood to pass through a column containing fixed adsorbent particles. During the process, various inflammatory cytokines are absorbed into resins inside the devices and removed from the circulation, attenuating systemic inflammation and leading to shock reversal.[3]

• HA330

HA330 hemoperfusion therapy can be used alone or in combination with other extracorporeal blood circulations, which provides a new therapy to reduce inflammatory mediators and cytokines for critically ill patients in ICU or those undergoing cardiac surgery.

Literatures Name: Removal of Humoral Mediators and the Effect on the Survival of Septic Patients by Hemoperfusion with Neutral Microporous Resin Column [4]

Clinical application: Inflammatory mediators and cytokines (IL-6, IL-8)

Clinical Benefits:^[4]

According to the results of a randomized controlled trial involving 44 patients, patients treated with HA330 hemoperfusion showed:

1. a significant removal of plasma IL-6 and IL-8.

2. significant increases in cardiac index, systemic vascular resistant index, fast withdrawal of vasoactive agents, and decreases in heart rate compared with the controls on days 3 and 7.

3. significant improvement in SOFA score demonstrated on day 14.

4. ICU mortality and the length of ICU stay in the HA group were markedly reduced.

• JF-800A

JF-800A is a platform which can be clinically used for hemoperfusion treatment, with a safety monitoring system. And it is compatible to varies hemoperfusion therapies. The machine encompasses multiple alarms for bubble, liquid level, venous and arterial pressure, ensuring reliability and systematic treatments.

*Note: Patient’s photos in the text are used with permission.

[1] What are Sepsis and Septic shocks? Available at: https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/septic-shock

[2] The serious effects brought by Sepsis. Available at: https://www.who.int/news/item/08-09-2020-who-calls-for-global-action-on-sepsis---cause-of-1-in-5-deaths-worldwide

https://clinicaltrials.gov/ct2/show/NCT05136183

[3] What is hemoperfusion? Available at: https://www.uptodate.com/contents/hemoperfusion

[4] Huang Z, Wang SR, Su W, Liu JY. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial. 2010 Dec;14(6):596-602. doi: 10.1111/j.1744-9987.2010.00825.x. PMID: 21118369.