New perspectives on the application of immunoadsorption for septic shock in the early postoperative period: the Efferon LPS approach

Background and goal of study: Loss of gastrointestinal integrity
after major abdominal surgery can promote bacterial translocation and lipopolysaccharide (LPS)–driven systemic inflammation,
precipitating septic shock. Hemoadsorption (HA) techniques
enable targeted removal of circulating inflammatory mediators;
however, clinical experience with newer LPS-selective systems
remains limited.
This work outlines the early postoperative use of the Efferon LPS
cartridge in a patient with severe abdominal sepsis and refractory
shock.
Materials and methods: An 87-year-old patient (Charlson Comorbidity Index 4) developed severe septic shock with diffuse
peritonitis following laparotomy for a perforated gastric ulcer. Due
to worsening circulatory failure (vasoactive-inotropic score [VIS]
34) and markedly elevated inflammatory biomarkers (CRP 195
mg/L; procalcitonin [PCT] 251 ng/mL; interleukin-6 [IL-6] 1629
pg/mL), a 10-hour HA session with the Efferon LPS cartridge was
initiated 11 hours postoperatively.
Treatment was delivered via a 13 Fr central venous catheter connected to a Prismaflex HP-X system, using systemic heparinisation (8 IU/kg) and a blood flow of 150 mL/min. Hemodynamic
variables, lactate, gas exchange, renal function, and inflammatory
markers were assessed at baseline, after HA completion (10 h),
and 48 h post-treatment.
Results and discussion: HA initiation was followed by progressive hemodynamic stabilisation. VIS decreased from 34 to 24 at
10 hours and reached 0 by 48 hours, while mean arterial pressure
rose from 65 to 75 mmHg. PCT and IL-6 concentrations declined
by 24% and 58%, respectively, at 10 hours. Lactate decreased
from 2.4 to 2.0 mmol/L. By 48 hours, organ function had measurably improved: PaO₂/FiO₂ ratio increased from 235 to 380,
and serum creatinine decreased from 191 to 131 µmol/L, with no
requirement for additional organ support. The patient was discharged from the ICU on postoperative day 4.
Conclusion(s): LPS-selective hemoadsorption with the Efferon
LPS cartridge was associated with rapid hemodynamic improvement, attenuation of inflammatory mediator levels, and recovery
of organ function in early postoperative septic shock.
While these findings suggest potential therapeutic benefit, controlled clinical studies are required to establish the efficacy, safety, and optimal indications for LPS-targeted HA in septic shock.