title: Endotoxin activity levels as a prediction tool for risk of deterioration in patients with sepsis not admitted to the intensive care unit: a pilot observational study.
abstract: OBJECTIVE
  The aim of this prospective observational study was to evaluate in patients with sepsis not requiring intensive care unit admission the relationship between the levels of endotoxin activity assay (EAA) early after sepsis recognition and the risk of development of organ dysfunction (OD).
  
  
  METHODS
  Endotoxin activity assay levels were drawn immediately after sepsis identification (baseline) and at 6, 24, and 48 hours postbaseline in 50 patients with signs of sepsis of a duration of less than 24 hours. An EAA 0.60 units or greater was considered as highly elevated.
  
  
  RESULTS
  Logistic regression showed independent association between EAA levels at baseline and the appearance of new OD (adjusted odd ratio, 2.41; 95% confidence interval, 1.18-4.90; P<.05). Fifteen patients (30%) who developed new OD after baseline had at least 1 EAA level 0.60 or greater. The adjusted linear regression analysis showed that across the 4 time points, EAA levels were significantly higher in patients who developed new OD (0.11; 95% confidence interval, 0.01-0.20; P<.05).
  
  
  CONCLUSIONS
  Endotoxin activity assay levels 0.60 or greater early after sepsis diagnosis in patients not requiring intensive care unit admission predict risk of development of new organ dysfunction. High EAA levels in the first 48 hours of recognition of sepsis are also predictive of risk of deterioration.
authors.affiliation: Anaesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41100 Modena, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Biagioni
authors.forename: Claudia
authors.initials: C
authors.lastname: Venturelli
authors.forename: David J
authors.initials: DJ
authors.lastname: Klein
authors.forename: Marta
authors.initials: M
authors.lastname: Buoncristiano
authors.forename: Fabio
authors.initials: F
authors.lastname: Rumpianesi
authors.forename: Stefano
authors.initials: S
authors.lastname: Busani
authors.forename: Laura
authors.initials: L
authors.lastname: Rinaldi
authors.forename: Abele
authors.initials: A
authors.lastname: Donati
authors.forename: Massimo
authors.initials: M
authors.lastname: Girardis
mesh_terms: D000368:Aged; D018450:Disease Progression; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000503:physiopathology; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood* / Q000503:physiopathology*; D012772:Shock, Septic / Q000097:blood / Q000503:physiopathology
chemical_list: D004731:Endotoxins
keywords: Endotoxin; Infection; Intensive care unit; Organ dysfunction; Severe sepsis; Shock