Endotoxin dosage in sepsis


Submitted: 13 February 2014
Accepted: 13 February 2014
Published: 31 March 2012
Abstract Views: 1475
PDF: 2057
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Introduction. Endotoxin, a component of the cell wall of Gram-negative bacteria is a major contributor to the pathogenesis of septic shock and multiple organ failure (MOF). Its entry into the bloodstream stimulates monocytes/macrophages which once activated produce and release cytokines, nitric oxide and other mediators that induce systemic inflammation, endothelial damage, organ dysfunction, hypotension (shock) and MOF.The aim of this study is to evaluate the usefulness of a quantitative test for the dosage of endotoxin to determine the risk of severe Gram-negative sepsis. Materials and methods. In the period January 2009 - June 2011 we performed 897 tests for 765 patients, mostly coming from the emergency room and intensive care, of which 328 (43%) women (mean age 53) and 437 (57%) male (mean age 49). Fifty-nine patients, no statistically significant difference in sex, were monitored by an average of two determinations of EA.All patients had procalcitonin values significantly altered.The kit used was EAA (Endotoxin Activity Assay) Estor Company, Milan, which has three ranges of endotoxin activity (EA): low risk of sepsis if <0.40 units, medium if between 0.40 and 0.59; high if 0.60. Results. 78 out of 765 patients (10%) had a low risk, 447 (58%) a medium risk and 240 (32%) a high risk.The dosage of EA, combined with that of procalcitonin, has allowed a more targeted antibiotic therapy. Six patients in serious clinical conditions were treated by direct hemoperfusion with Toraymyxin, a device comprising a housing containing a fiber polypropylene and polystyrene with surface-bound polymyxin B, an antibiotic that removes bacterial endotoxins from the blood. Conclusions.The test is useful in risk stratification as well as Gram negative sepsis, to set and monitor targeted therapies, also based on the neutralization of endotoxin.

Rondinelli, V., Giglio, S., Focarelli, V., Saraceno, R., Minchella, P., Lepore, M. G., Iiritano, N., Castagna, S., Opipari, P., Alcaro, T., Balducci, A., & Masciari, R. (2012). Endotoxin dosage in sepsis. Microbiologia Medica, 27(1). https://doi.org/10.4081/mm.2012.2333

Downloads

Download data is not yet available.

Citations