Why measure endotoxin in septic shock patients?

Introduction

The aim of the present study was to evaluate the clinical utility of endotoxin activity (EAA) measurement in critically ill septic shock (SS) patients.

Methods

From January 2007 to August 2007 in an eight-bed general ICU, we performed a prospective analysis of the EAA level on 29 critically ill patients within 24 hours of SS diagnosis (CDC criteria). The EAA level was assessed by a new and rapid assay based on neutrophil-dependent chemioluminescence. The EAA level (defined as low, intermediate and high, respectively, for values <0.40, 0.40–0.60, and ≥ 0.6) was then correlated with severity of illness and ICU mortality.

Results

The clinical profile of SS patients is shown in Table 1. The EAA level was low in a minority of SS patients (13%), and intermediate and high EAA levels were evidenced in 31% and 56% of SS patients, respectively (Table 2). Our results seem to evidence a good correlation between EAA levels and severity of illness (Table 2). The EAA level seems to correlate with ICU mortality, which was 0% in low EAA patients, and 17% and 37% in intermediate and high EAA patients.

Table 1 Clinical profile of septic shock patients

Table 2 Endotoxin activity (EAA) level and severity of illness

Conclusion

Although our sample is too small to reach statistical significance, the EAA level could be a good marker of severity in SS patients. A high level of EAA seems to correlate with worse prognosis in SS patients.