Measurement of endotoxaemia by the Limulus test

Mf, Scully

doi:10.1007/bf00258060

Cited by 10 publications

(5 citation statements)

References 8 publications

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“…These observations prompted speculation that a reliable, rapid endotoxin assay might identify a population of patients with circulating endotoxemia who could theoretically benefit from the administration of an anti-endotoxin treatment strategy. The current 'gold standard' for the determination of endotoxemia is the LAL assay, which requires specific expertise to perform and is notorious for a wide variability in results [ 4 , 5 ].…”

Section: Targeted Administration Of Anti-endotoxin Therapymentioning

confidence: 99%

“…Endotoxin plays a central role in sepsis [ 2 , 3 ]. The current 'gold standard' for the determination of endotoxemia is the limulus amebocyte lysate (LAL) assay, which requires specific expertise to perform and which is notorious for wide variability in results [ 4 , 5 ]. Would the EAA evaluated by Marshall and colleagues be more reliable?…”

Section: Introductionmentioning

confidence: 99%

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Balk

2002

Crit Care

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The detection of endotoxemia may provide a clue to the cause of sepsis or may indicate translocation of endotoxin from the gastrointestinal tract. A reliable endotoxin activity assay (EAA) offers the potential to determine Gram-negative infections in critically ill patients. In addition, a reliable EAA may indicate the adequacy of gastrointestinal tract perfusion, as well as potentially help to predict morbidity and mortality. A recent study by Marshall and colleagues, published in the present issue of Critical Care, evaluated the use of a whole blood EAA in a medical–surgical intensive care unit and found that 58% of the patients had positive endotoxin assays. However, only 13.5% of the population had a documented Gram-negative infection. This discrepancy and the observation that translocation and other causes of endotoxemia may not reflect true Gram-negative infection might severely limit the clinical utility of this EAA. Further study may better define the potential role of this technique in the diagnostic evaluation of the critically ill patient.

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Section: Targeted Administration Of Anti-endotoxin Therapymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Untitled

Balk

2002

Crit Care

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“…Negative Bacterium has been used as the endpoint of the reaction to indicate the presence of endotoxin. However, nonspecific gelation has been reported, and interpretation of what represents adequate gelation has been a major source of confusion (12). In 1978, Iwanaga et al (18) introduced a quantitative endotoxin assay using a synthetic chromogenic peptide as a substrate for the endotoxin-sensitive limulus enzyme ( Figure 2).…”

Section: Cell Wallmentioning

confidence: 99%

“…The test is approved by the Food and Drug Administration (3) for screening of pharmaceutical products. However, application of the test to detection of endotoxin in plasma presents several difficulties due to inactivation of endotoxin and the presence of inhibitors in plasma to the endotoxin-sensitive limulus enzyme (12,16,17). Until recently, gelation of the test medium…”

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confidence: 99%

Endotoxin levels measured by a chromogenic assay in portal, hepatic and peripheral venous blood in patients with cirrhosis

1988

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Endotoxin concentrations were measured in the portal, hepatic and peripheral venous blood of two groups of patients with cirrhosis using a limulus-based chromogenic assay. The high sensitivity of chromogenic detection allowed measurement of endotoxin as low as 10 to 15 pg per ml, an order of magnitude greater than previously possible by gelation studies. Group 1 consisted of 56 patients with cirrhosis undergoing angiographic evaluation. In this group, there was wide variability in hepatic venous concentration [73 +/- 110 pg per ml (mean +/- S.D.)] and peripheral venous concentration [31 +/- 58 pg per ml]. However, paired t test showed peripheral venous concentration was significantly (p less than 0.001) lower than hepatic venous concentration. Neither hepatic or peripheral venous endotoxin levels correlated significantly with a variety of clinical, biochemical or radiological parameters. Group 2 consisted of 21 patients with cirrhosis undergoing shunt surgery. Endotoxin levels again showed a wide range, with portal venous concentration (142 +/- 167 pg per ml) and simultaneous peripheral venous concentration (82 +/- 150 pg per ml). Paired t test in this group showed a significant (p less than 0.001) portal to peripheral venous gradient. This study showed the feasibility of measuring endotoxin in plasma to low concentrations by a chromogenic assay technique. It supports the concept of relatively high levels of endotoxin in the portal circulation. In the presence of liver disease, systemic endotoxemia occurs, which is augmented by stressful situations.

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“…Activation of the chromogenic sub strate can occur with plasma amidases includ ing thrombin, plasmin and urokinase [38]. Loss of endotoxin activity occurs within min utes in blood stored at room temperature [36] so samples should be placed on ice and plasma extracted as soon as possible [31], Various methods have been proposed to re move the effect of these proteins including alkali treatment [35], pH shift [30], chloro form extraction [25], perchloric acid [26], water dilution [25], and dilution and heating [11,36]. Comparisons of these techniques have shown that dilution and heating, be cause of its effectiveness and simplicity, is the method of choice [9, 15,34], and was adopted in this study.…”

Section: Lal Assaymentioning

confidence: 99%

Measurement of Operative Plasma Endotoxin Levels in Jaundiced and Non-Jaundiced Patients

Pain

Bailey²

1987

Eur Surg Res

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A study of portal plasma endotoxin levels was performed using a chromogenic limulus amoebocyte lysate (LAL) assay. The assay proved sensitive and reproducible. In only 1 of 25 healthy subjects was the systemic plasma endotoxin level above 100 pg/ml (equivalent Escherichia coli 0111B4). In 30 non-jaundiced patients undergoing surgery the mean (+SEM) portal plasma endotoxin level (60 + 9 pg/ml) was significantly higher (p < 0.05) than the mean level in the systemic blood (46 + 6 pg/ml), supporting the concept of endotoxin absorption from the intestine into the portal blood. In 20 patients with obstructive jaundice undergoing surgery 42% of portal, 45% of inferior mesenteric and 35% of systemic venous plasma endotoxin levels were above 100 pg/ml. There were significantly higher levels in the portal (p < 0.05) and inferior mesenteric (p < 0.05) compared with the systemic blood. Neither the presence of malignancy nor the duration of surgery appeared to influence endotoxin absorption. The significance of raised plasma endotoxin levels in obstructive jaundice is discussed.

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Measurement of endotoxaemia by the Limulus test

Cited by 10 publications

References 8 publications

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Untitled

Endotoxin levels measured by a chromogenic assay in portal, hepatic and peripheral venous blood in patients with cirrhosis

Measurement of Operative Plasma Endotoxin Levels in Jaundiced and Non-Jaundiced Patients

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