Prognostic value of endotoxin activity assay in patients with severe sepsis after cardiac surgery

Yaroustovsky, M.B.; Plyushch, Marina; Popov, D. A.; Самсонова, Н. Г.; Abramyan, Marina; Popok, Z V; Кротенко, Н. П.

doi:10.1186/1476-9255-10-8

Cited by 40 publications

(43 citation statements)

References 14 publications

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“…Conversely, Lassenius et al 26 report an average concentration 600x these values (60 ±9 EU/mL) in 345 healthy individuals. To complicate matters more, others have reported endotoxin concentrations of septic individuals below 1 EU/mL 104 . Furthermore, some groups report endotoxin concentrations in pg/mL, with absolute values of endotoxin differing greatly between studies 25, 60, 83 .…”

Section: Endotoxin Detection: Limitations With Measurement In Bloodmentioning

confidence: 99%

Metabolic endotoxemia with obesity: Is it real and is it relevant?

et al. 2016

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Obesity is associated with metabolic derangements in multiple tissues, which contribute to the progression of insulin resistance and the metabolic syndrome. The underlying stimulus for these metabolic derangements in obesity are not fully elucidated, however recent evidence in rodents and humans suggests that systemic, low level elevations of gut derived endotoxin (lipopolysaccharide, LPS) may play an important role in obesity related, whole-body and tissue specific metabolic perturbations. LPS initiates a well-characterized signaling cascade that elicits many pro-and anti-inflammatory pathways when bound to its receptor, Toll-Like Receptor 4 (TLR4). Low-grade elevation in plasma LPS has been termed “metabolic endotoxemia” and this state is associated with a heightened pro-inflammatory and oxidant environment often observed in obesity. Given the role of inflammatory and oxidative stress in the etiology of obesity related cardio-metabolic disease risk, it has been suggested that metabolic endotoxemia may serve a key mediator of metabolic derangements observed in obesity. This review provides supporting evidence of mechanistic associations with cell and animal models, and provides complimentary evidence of the clinical relevance of metabolic endotoxemia in obesity as it relates to inflammation and metabolic derangements in humans. Discrepancies with endotoxin detection are considered, and an alternate method of reporting metabolic endotoxemia is recommended until a standardized measurement protocol is set forth.

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Section: Endotoxin Detection: Limitations With Measurement In Bloodmentioning

confidence: 99%

Metabolic endotoxemia with obesity: Is it real and is it relevant?

et al. 2016

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“…In the presence of β‐glucan and luminol, neutrophils undergo a respiratory burst accompanied by light emission. The light produced is quantified using a chemiluminometer, and its intensity is proportional to the amount of Et present in the sample …”

Section: Methodsmentioning

confidence: 99%

“…Notably, this assay was reported to constitute a better diagnostic tool for sepsis than the kinetic turbidimetric Limulus test, which is widely used for detecting Ets . The EAA might be particularly useful for the early identification of patients who are at high risk of developing severe sepsis and septic shock . In the current study, we used this assay to investigate the relationship between endotoxemia and ADAMTS13:AC, and its related parameters, and attempted to determine whether imbalance of the enzyme–substrate ratio associated with endotoxemia contributes to the development of MOF through microcirculatory disturbances in patients with acute cholangitis.…”

Section: Introductionmentioning

confidence: 99%

Platelet hyperaggregability is associated with decreased ADAMTS13 activity and enhanced endotoxemia in patients with acute cholangitis

Takaya

Kawaratani

Kubo

et al. 2017

Hepatology Research

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“…Taking into account the recommendations of several other authors [6,8,][28], the dynamics of the endotoxin load were assessed before the procedures and within 12 h after the end of treatment because the ‘re-equilibration' of endotoxin concentrations requires a long period of time.…”

Section: Discussionmentioning

confidence: 99%

“…It activates macrophages leading for example to the release of acute-phase proteins, cytokines, chemokines and complement factors [4]. High endotoxin levels in the blood in the perioperative period are associated with an increased risk of infectious complications and multiple organ dysfunction syndrome development [5,6,7,8]. …”

Section: Introductionmentioning

confidence: 99%

Combined Extracorporeal Therapy for Severe Sepsis in Patients after Cardiac Surgery

Yaroustovsky¹,

Abramyan²,

Кротенко³

et al. 2014

Blood Purif

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Introduction: Sepsis still represents an obstacle in modern medicine. The aim of this study was to evaluate the effectiveness and safety of the combined use of lipopolysaccharide adsorption and haemodialysis (HD) with high cut-off haemofilters as part of the complex intensive care of patients with severe sepsis after cardiac surgery. Methods: The study group included 26 patients, 57 (48-62) years of age, with severe sepsis. The inclusion criteria were clinical signs of severe sepsis (systemic inflammatory response syndrome + infection site + failure of two or more organs) together with endotoxin activity assay (EAA) ≥0.6 and procalcitonin (PCT) levels ≥2 ng/ml. Antimicrobial therapy was initiated in the first hour after the diagnosis of severe sepsis and extracorporeal therapy was initiated within 24 h. All of the patients in the study group received standard therapy. Additionally, they received treatment consisting of two LPS adsorption procedures and HD procedures with high cut-off haemofilters in a single circuit. For the control group, 30 comparable patients, 57 (51-61) years of age, were selected and received only standard therapy. Results: After the last HD procedure within the extracorporeal therapy, we noted an increase in the mean arterial pressure from 76 to 90 mm Hg, p < 0.01, and oxygenation index (from 226 to 291, p < 0.02), in addition to decreases in the LPS concentration according to EAA (from 0.73 to 0.59, p < 0.01) and the Limulus amebocyte lysate test (from 1.44 to 0.36 IU/ml, p < 0.01); PCT falls from 8.19 to 2.44 ng/ml, p < 0.01, and sepsis-related organ failure assessment scores decreases from 13 to 10, p = 0.007. When we compared the data between the study group the day after the procedures and the control group 3 days after the start of intensive care, we discovered that there were statistically significant differences in mean arterial pressure (90 vs. 81 mm Hg, p = 0.0004), oxygenation index (291 vs. 229, p = 0.01), and EAA levels (0.59 vs. 0.67, p = 0.05). Differences in the PCT were not significant (2.44 vs. 3.41, p = 0.15). The 28-day survival rate in the study group was higher than that in the control group (65.4 vs. 33.3%, p = 0.03). Conclusion: The combined use of LPS adsorption and HD with high cut-off haemofilters in conjunction with standard therapy is a safe, effective method for treating patients who have severe sepsis.

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Prognostic value of endotoxin activity assay in patients with severe sepsis after cardiac surgery

Cited by 40 publications

References 14 publications

Metabolic endotoxemia with obesity: Is it real and is it relevant?

Metabolic endotoxemia with obesity: Is it real and is it relevant?

Platelet hyperaggregability is associated with decreased ADAMTS13 activity and enhanced endotoxemia in patients with acute cholangitis

Combined Extracorporeal Therapy for Severe Sepsis in Patients after Cardiac Surgery

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