-Case Reports-

Effectiveness of Endotoxin Scattering Photometry for Determining the Efficacy of Polymyxin B-immobilized Fiber Treatment in Septic Shock: Report of a Case

Yuichiro Sakamoto^1,2, Kunihiro Mashiko^1,2, Toru Obata³ and Hiroyuki Yokota¹

¹Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Nippon Medical School
²Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusoh Hospital
³Department of Molecular Cell Biology, Institute of DNA Medicine, The Jikei University School of Medicine

The limulus test, which has been established as a test for endotoxin measurement, is associated with problems, including that posed by the presence of a response inhibitor factor and the longer time needed for the measurement of low concentrations. On the other hand, the technique of direct hemoperfusion with a polymyxin B immobilized fiber column (DHP-PMX) was developed in Japan in 1994 and has been used for the control of endotoxemia in septic shock. The limulus test, which is a common endotoxin measurement test, has several problems with regard to sensitivity. Therefore, this test is no longer used to determine the effectiveness of DHP-PMX. Here, we describe a patient presenting with colonic perforation who recovered from septic shock with DHP-PMX. This treatment effect was reflected by a decrease in plasma endotoxin levels as demonstrated more readily with endotoxin scattering photometry assay than with the standard limulus test. We conclude that endotoxin measurement with endotoxin scattering photometry is superior to nephelometry in patients with endotoxemia.

J Nippon Med Sch 2010; 77: 119-122

Keywords
polymyxin B-immobilized fiber (PMX), septic shock, endotoxin scattering photometry

Correspondence to
Yuichiro Sakamoto, Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamakari, Inba-mura, Inba-gun, Chiba 270-1694, Japan
y-sakamoto@nms.ac.jp

Received, November 4, 2009
Accepted, December 8, 2009