Case Report: Interleukin-6-guided early cytokine-adsorbing polymethylmethacrylate continuous hemodiafiltration in sepsis-induced disseminated intravascular coagulation
Year: 2026
Type: article
Abstract: Immunothrombosis, in which interleukin-6 (IL-6) is one of several key mediators, underlies sepsis-induced disseminated intravascular coagulation (DIC) and its progression to multiorgan dysfunction. Polymethylmethacrylate continuous hemodiafiltration (PMMA-CHDF) is an extracorporeal blood-purification therapy that adsorbs IL-6 and other inflammatory mediators independently of renal replacement, but biomarker-based patient selection is undefined. We describe a 59-year-old woman with sigmoid diverticular perforation and polymicrobial gut-origin infection who developed septic DIC despite prompt source control and broad-spectrum antimicrobials. At the treatment-decision timepoint on hospital day 1, the Acute Physiology and Chronic Health Evaluation II score was 28, the Sequential Organ Failure Assessment (SOFA) score was 7, and serum IL-6 exceeded 50,000 pg/mL. The concurrent Japanese Association for Acute Medicine DIC (JAAM-DIC) score, however, was still sub-diagnostic (2 of the required ≥ 4). An institutional IL-6/SOFA logistic model nonetheless returned a predicted DIC probability of 0.880, above the 0.810 cutoff, which supported the decision to treat. Conventional JAAM-DIC criteria were met approximately three hours later (score 5). PMMA-CHDF was initiated for cytokine adsorption rather than renal replacement, combined with the antithrombotic agents recombinant human soluble thrombomodulin and antithrombin III, with fresh frozen plasma given for factor replacement. Over the first four hospital days, serum IL-6 fell from above 50,000 to 139 pg/mL, the SOFA score from 7 to 3, and the JAAM-DIC score from 5 to 2; the IL-6 decline continued after PMMA-CHDF was withdrawn. The subsequent course was free of new organ dysfunction, with no further vasopressors and no re-intubation. This case is a worked example of biomarker-guided, early cytokine adsorption. An internally derived IL-6/SOFA model crossed its DIC-probability threshold while conventional criteria were still unmet, supporting the earliest feasible, time-limited cytokine and coagulation control. Efficacy cannot be inferred from a single case, and source control and antimicrobials were the foundation of treatment. What this case illustrates is the biomarker-guided selection and timing of treatment, which we propose as a candidate for prospective testing in hypercytokinemic septic DIC.
Source: Frontiers in Medicine
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7225745906