Endotoxin assay with endotoxin scattering photometry is one of the diagnostic markers of sepsis

Introduction

Endotoxin scattering photometry (ESP) is one of a newly developed clinically applicable method for endotoxin assay. Although ESP is an analogous assay of turbidimetric method, it enables one to detect very small amounts of endotoxin within 1 hour. This is because ESP can directly detect clotting enzyme product, coagulin, which is the first appearance of Limulus amebocyte lysate (LAL) cascade and the precursor of gel clots.

Methods

To study the correlates and prognostic significance of the endotoxin assay with ESP, we enrolled a total of 80 people consisting of three groups which were normal healthy volunteers (n = 35), patients admitted to the emergency department (ED) (n = 21) and patients admitted to the ICU (n = 24). To examine whether endotoxin is influencing in the severity of disease, we used sepsis/SIRS stratification which was defined by the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM).

Results

Of all 80 people, 33.7% (n = 27) was sepsis. The levels of endotoxin were significantly higher in the patients with sepsis (median, 18.4 pg/ml; interquartile range, 3 to 54.1 pg/ml) than in the people without sepsis (0.227 pg/ml; 0.031 to 0.493 pg/ml). The area under the receiver operating characteristic curve was 0.951 in the patients with sepsis. Cut-off concentrations for optimum prediction of sepsis with ESP were endotoxin >7.06 pg/ml (diagnostic efficiency: 92.6%).

Conclusions

Endotoxin assay with ESP is one of the diagnostic markers of sepsis because the levels of endotoxin in patient with sepsis are clearly high. Endotoxin assay with ESP concentration higher than 7.06 pg/ml indicates sepsis.