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The limitations of endotoxin hemoadsorption therapy (PMX-DHP) and the optimal time to start PMX-DHP were examined in patients with septic multiple organ failure with hypercytokinemia (IL-6 > 1000 pg/ml). This study included 66 patients with infectious systemic inflammatory response syndrome in whom IL-6 > 1000 pg/ml before PMX-DHP therapy. These subjects were separated into two groups, those who survived for more than 28 days after the start of PMX-DHP therapy (S group; 38 patients) and those who did not survive (N-S group; 28 patients). Severity of symptoms and background factors, hemodynamic parameters, PaO2/FiO2, endotoxin, cytokines (TNF-α, IL-6, IL-1ra), and vascular endothelial cell function-related markers (ICAM-1, ELAM-1, PAI-1) were examined before and after PMX-DHP. Statistical analyses were performed by chi-squared test for background factors, with Wilcoxon's signed rank test for comparison within a group, and Mann–Whitney's U test for comparison between groups. This study was approved by the IRB of Tokyo Medical University.