title: Reappraisal with meta-analysis of bacteremia, endotoxemia, and mortality in gram-negative sepsis.
abstract: Among patients with suspected sepsis, endotoxemia is variably present in association with gram-negative bacteremia. A total of 738 patients with suspected sepsis from 11 studies could be classified into four groups: 131 (18%) patients had both endotoxemia and gram-negative bacteremia (group 1), 87 (12%) had only gram-negative bacteremia (group 2), and 143 (19%) had only endotoxemia (group 3); in 377 (51%) patients neither could be detected (group 4). By the statistical techniques of meta-analysis, the fatality risk for patients with either endotoxemia or gram-negative bacteremia or both was estimated with group-specific case fatality rates from these studies and expressed as an odds ratio (OR; 95% confidence interval [95% CI]) versus patients with these factors absent. This risk was increased marginally when endotoxemia was detected without gram-negative bacteremia (OR, 2.3; 95% CI, 1.3 to 4.0) or the converse (OR, 2.0; 95% CI, 1.0 to 3.8), in contrast to the striking increase when both endotoxemia and gram-negative bacteremia were detected (OR, 6.3; 95% CI, 4.0 to 10.0). Alone, neither endotoxemia nor gram-negative bacteremia is a strong predictor of outcome in patients with suspected sepsis. However, in combination, the two identify a subpopulation with a substantially increased risk of mortality.
authors.affiliation: Division of Infectious Diseases, Children's Hospital and Medical Center, Seattle, Washington 98105-0371, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Hurley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004731:Endotoxins / Q000097:blood*; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000401:mortality; D006801:Humans; D007223:Infant; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D014115:Toxemia / Q000150:complications* / Q000401:mortality
chemical_list: D004731:Endotoxins