title: Diagnostic and prognostic implications of endotoxemia in critical illness: results of the MEDIC study.
abstract: A novel assay for endotoxin, based on the ability of antigen-antibody complexes to prime neutrophils for an augmented respiratory burst response, was studied in a cohort study of 857 patients admitted to an intensive-care unit (ICU). On the day of ICU admission, 57.2% of patients had either intermediate (>or=0.40 endotoxin activity [EA] units) or high (>or=0.60 units) EA levels. Gram-negative infection was present in 1.4% of patients with low EA levels, 4.9% with intermediate levels, and 6.9% with high levels; EA had a sensitivity of 85.3% and a specificity of 44.0% for the diagnosis of gram-negative infection. Rates of severe sepsis were 4.9%, 9.2%, and 13.2%, and ICU mortality was 10.9%, 13.2%, and 16.8% for patients with low, intermediate, and high EA levels, respectively. Stepwise logistic regression analysis showed that elevated Acute Physiology and Chronic Health Evaluation II score, gram-negative infection, and emergency admission status were independent predictors of EA.
authors.affiliation: University Health Network, University of Toronto, Toronto, Ontario, Canada. john.marshall@uhn.on.ca
authors.forename: John C
authors.initials: JC
authors.lastname: Marshall
authors.forename: Debra
authors.initials: D
authors.lastname: Foster
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohen
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.forename: Steven
authors.initials: S
authors.lastname: Opal
authors.forename: Edward
authors.initials: E
authors.lastname: Abraham
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Brett
authors.forename: Terry
authors.initials: T
authors.lastname: Smith
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.forename: Anastasia
authors.initials: A
authors.lastname: Derzko
authors.forename: Alex
authors.initials: A
authors.lastname: Romaschin
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000818:Animals; D015331:Cohort Studies; D016638:Critical Illness; D019446:Endotoxemia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D004731:Endotoxins / Q000097:blood*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008163:Luminescent Measurements; D008297:Male; D051379:Mice; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D018805:Sepsis / Q000453:epidemiology; D012720:Severity of Illness Index
chemical_list: D004731:Endotoxins