Skip to content


Critical Care

Volume 18 Supplement 2

Sepsis 2014

Open Access

Early diagnosis of sepsis due to Gram-negative infection with the Endotoxin Activity Assay

  • M Kang1,
  • M Tsunoda1,
  • M Saito1,
  • N Saito1,
  • M Namiki1,
  • M Takeda1,
  • T Harada1 and
  • A Yaguchi1
Critical Care201418(Suppl 2):P74

Published: 3 December 2014


Body TemperatureEarly DiagnosisDiagnostic TestSevere SepsisPositive Predictive Value


The Endotoxin Activity Assay (EAA™; Spectral Diagnostics Inc., Toronto, Canada) is a rapid in vitro diagnostic test of the neutrophil reaction to endotoxin and reflects the endotoxemia. A higher value of EAA (>0.60) has been shown to correlate with developing severe sepsis and a high mortality in other previous studies. We hypothesize that a value of EAA more than 0.55, not >0.60, may be useful to earlier diagnose sepsis due to Gram-negative organisms and to assess the severity.


The present study is a single-center retrospective observational analysis of adult septic patients in whom EAA was performed from July 2008 to July 2013. Patients were divided into two groups: (1) EAA >0.55 and (2) EAA < 0.54. Age, sex, days of ICU stay, ICU mortality, body temperature, WBC, CRP, procalcitonin (PCT), SOFA score, and microbiological data were compared between two groups. Values are expressed as mean ± SD. Data were analyzed by chi-square test and Mann-Whitney U test. P < 0.05 was considered significant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and odds ratio were also evaluated.


Five hundred and ninety-four patients (377 men and 217 women; mean age 65.0 ± 17.5 years) were studied. There were (1) 104 patients with EAA >0.55 and (2) 490 patients with EAA < 0.54. ICU mortality (39.4 vs. 26.6 %, P = 0.01), PCT (17.2 ± 36.0 vs. 11.8 ± vs. 30.6 ng/ml, P = 0.04), SOFA score (8.1 ± 4.9 vs. 6.2 ± 4.6, P = 0.04) and positive Gram-negative organisms in cultures (57.7 vs. 45.5 %, P = 0.02) were significantly higher in group (1) than group (2). Age, sex, body temperature, WBC and CRP were not significantly different between two groups. Using detections of Gram-negative organisms in cultures, the sensitivity, the specificity, the PPV and the NPV were 22.1, 85.2, 57.7 and 54.6%, respectively. The odds ratio was 1.64.


ICU mortality and severity were higher in patients with EAA >0.55 than in patients with EAA < 0.54. There is a possibility that an EAA value more than 0.55 is a meaningful value for early diagnosis of sepsis due to Gram-negative infection.

Authors’ Affiliations

Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan


© Kang et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.