title: The importance of early detection of endotoxemia.
abstract: Endotoxin is considered a key signaling molecule in the pathogenesis of sepsis and septic shock. Anti-endotoxin therapies may result in the improvement of a patient's clinical condition and lower mortality. The pressing clinical challenge is to identify patients for whom endotoxin elimination would be the most beneficial. An endotoxin activity assay (EAA) has been available for detection of endotoxins, allowing selection of patients at high risk of endotoxemia in intensive care units (ICUs). We studied a cohort of 172 consecutive patients who had septic shock on admission to the ICU. Endotoxin activity (EA) was measured with a rapid chemiluminescent EAA, regarded as point-of-care testing. Endotoxemia with a mean EA of 0.59 ± 0.14 EAU was present in 104 patients (60%) and absent in 68 patients (EA = 0.25 ± 0.11 EAU). The risk of endotoxemia increased with the presence of a Gram-negative infection [odds ratio (OR) 3.1, 95% confidence interval (CI) 1.6-5.9; P = 0.001] and bacteremia (OR 3.8, 95% CI 1.6-8.9; P = 0.02) but did not change with a diagnosis of peritonitis (OR 1.03, 95% CI 0.54-1.97; P = 0.90). These findings indicate that anti-endotoxin interventions should be tailored to individual patients based on both clinical conditions and measured endotoxin levels.
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556 Wroclaw, Poland barbara.adamik@umed.wroc.pl.
authors.forename: Barbara
authors.initials: B
authors.lastname: Adamik
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556 Wroclaw, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Smiechowicz
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556 Wroclaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kübler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care; D042241:Early Diagnosis; D019446:Endotoxemia / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000453:epidemiology; D000067716:Point-of-Care Testing; D057285:Precision Medicine; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology; D015398:Signal Transduction; D055815:Young Adult
keywords: Endotoxemia; mortality; point-of-care testing; sepsis; septic shock