Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease.
We studied prospectively the quantitative relation of circulating endotoxin (lipooligosaccharides [LOSs]) and the development of multiple organ failure and death in 45 consecutively admitted patients with bacteriologically verified systemic meningococcal disease (SMD). A plasma LOS level of greater than 700 ng/L correlated with development of severe septic shock (P less than .0001), adult respiratory distress syndrome (P = .0035), a pathologically elevated serum creatinine level (P less than .0001), or death as a consequence of multiple organ failure (P = .0002). Initial plasma LOS levels of less than 25, 25-700, 700-10,000, and greater than 10,000 ng/L were associated with 0%, 14%, 27%, and 86% fatality, respectively. The LOS half-life after initiation of antibiotic therapy was 1-3 h. Increasing plasma LOS levels were never seen. These observations suggest that LOS quantitation using the limulus amebocyte lysate assay with a chromogenic substrate gives important progsnotic information and may provide new insight concerning pathophysiological aspects of SMD.
Brandtzaeg
P
P
Department of Infectious Diseases, Ullevål University Hospital, Oslo, Norway.
Kierulf
P
P
Gaustad
P
P
Skulberg
A
A
Bruun
J N
JN
Halvorsen
S
S
Sørensen
E
E
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006801:Humans; D007223:Infant; D008070:Lipopolysaccharides / Q000097:blood*; D008297:Male; D008585:Meningitis, Meningococcal / Q000097:blood / Q000150:complications* / Q000401:mortality; D009102:Multiple Organ Failure / Q000503:physiopathology*; D009345:Neisseria meningitidis / Q000302:isolation & purification; D011379:Prognosis; D012772:Shock, Septic / Q000097:blood* / Q000150:complications / Q000401:mortality
D004731:Endotoxins; D008070:Lipopolysaccharides; C023023:lipid-linked oligosaccharides