敗血症性多臓器不全に対するPlasma Filtration with Dialysis[Plasma Dia-filtration (PDF)](<特集>敗血症とアフェレシス)

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The mortality rate in severe sepsis is 40-50%. In the early phase of sepsis, high flow-volume hemodiafiltration and PMX-DHP have been reported to be useful, whereas no modality in the late phase. We reported that a novel plasmapheresis, plasma filtration with dialysis, was useful for patients with acute liver failure and sepsis. In our multicenter study, 48 patients with septic multiple organ failure were enrolled and received PDF. On average, 10.3±14.0 sessions (range 1-70) per patient were performed. The 28-day mortality rate was 43.5%, while the predicted death rate was 69.2±17.3%. Among the 48 patients, the 21 patients in a single center were sub-analyzed for the timing of PDF treatment relative to ICU admission and clinical outcome. We stratified patients into early PDF (denned by the start within 2 days; 29%) delayed PDF (between 2 and 5 days; 24%), and late PDF (after 5 days from ICU admission; 48%). Late and delayed PDFs were not associated with high mortality as compared with early PDF (50% vs 40% vs 83%). These findings suggest that PDF may become a useful strategy for treatment of patients with septic multiple organ failure, especially from the delayed to late phase.
2012-05-31