Prevalence of endotoxemia after surgery and its association with ICU length of stay.
BACKGROUND
The aim of this observational study was to investigate the prevalence of endotoxemia after surgery and its association with ICU length of stay.


METHODS
102 patients admitted to a university ICU after surgery were recruited. Within four hours of admission, functional data were collected and APACHE II severity score calculated. Arterial blood samples were taken and endotoxemia was measured by chemiluminescence (Endotoxin Activity (EA)). Patients were stratified according to their endotoxin levels (low, intermediate and high) and according to their surgical procedures. Differences between endotoxin levels were assessed by ANOVA, accepting P < 0.05 as significant. Data are expressed as mean +/- SD.


RESULTS
EA levels were low in 68 (66%) patients, intermediate in 17 (17%) and high in 17 (17%). Age (61 +/- 17 years) and APACHE II score 8.3 +/- 3.7 (P = 0.542) were not significantly different in the three EA groups. Functional parameters on admission were similar between EA groups: white blood cells 11093 +/- 4605 cells/mm3 (P = 0.385), heart rate 76 +/- 16 bpm (P = 0.898), mean arterial pressure 88.8 +/- 13.6 mmHg (P = 0.576), lactate 1.18 +/- 0.77 mmol/L (P = 0.370), PaO2/FiO2 383 +/- 109 mmHg (P = 0.474). Patients with high levels of EA were characterized by longer length of stay in the ICU: 1.9 +/- 3.0 days in the low EA group, 1.8 +/- 1.4 days in intermediate and 5.2 +/- 7.8 days in high group (P = 0.038).


CONCLUSIONS
17% of our patients were characterized by high levels of endotoxemia as assessed by EA assay, despite their low level of complexity on admission. High levels of endotoxin were associated with a longer ICU length of stay.
Valenza
Franco
F
Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS - Ospedale Maggiore Policlinico Mangiagalli Regina Elena, 20122 Milano, Italy. franco.valenza@unimi.it
Fagnani
Lorella
L
Coppola
Silvia
S
Froio
Sara
S
Sacconi
Francesca
F
Tedesco
Cecilia
C
Maffioletti
Micol
M
Pizzocri
Marta
M
Salice
Valentina
V
Ranzi
Maria Luisa
ML
Marenghi
Cristina
C
Gattinoni
Luciano
L
D000704:Analysis of Variance; D019446:Endotoxemia / Q000453:epidemiology*; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence