Usefulness of the endotoxin activity assay as a biomarker to assess the severity of endotoxemia in critically ill patients

Abstract

The aim of this study was to investigate the prevalence of endotoxemia in critically ill Japanese patients using the endotoxin activity assay, a newly developed rapid assay of endotoxin. The endotoxin levels (EA levels) in the blood of 314 patients admitted to our university hospital's intensive care unit (ICU) were measured within 24 h of admission, and its correlation with disease severity and outcome examined. In addition, the EA levels in 61 samples from healthy volunteers were measured. EA level was 0.39 ± 0.25 (mean ± SD) in patients admitted to the ICU and 0.10 ± 0.09 in healthy controls. There was less overlap of EA level distribution between patients and controls compared with previous reports measuring EA level in mainly Caucasian populations. Our patients' EA levels were significantly correlated with disease severity criteria and 28-d mortality. When EA and procalcitonin levels were used concomitantly, disease severity could be assessed more precisely than when either marker was used alone. These results suggest that EA level is a useful marker for disease severity assessment and outcome prediction in critically ill patients.

Quantitative lipopolysaccharide analysis using HPLC/MS/MS and its combination with the limulus amebocyte lysate assay

“…These results are in agreement with earlier studies, which showed that endotoxemia was related to disease severity, the SOFA score, a higher plasma lactate concentration, lower systemic vascular resistance, depressed ejection fractions, a greater need for vasopressors, and a greater risk of dying (35)(36)(37). Thus, it can be anticipated that LPS measurement by HPLC/MS/MS could become a promising tool in the diagnosis, follow-up, and therapeutic management of patients with sepsis.…”

Proton pump inhibitor therapy does not increase serum endotoxin activity in patients with cirrhosis

“…Endotoxin activity is expressed in relative units derived from the integral of the basal and stimulated chemiluminescent response (on a scale from 0 to 1). Most of the EA levels of healthy controls are <0.2, with 72% being <0.1, and 16% being between 0.1 and 0.2 . An EA level of 0.4 is approximately equivalent to an endotoxin concentration of 25–50 pg/mL, and a level of 0.6 is approximately equivalent to a lipopolysaccharide concentration of 100–200 pg/mL.…”

Selecting DNA aptamers for endotoxin separation

“…These biological effects include affecting the structures and functions of cells and organs, raising body temperature, triggering the coagulation cascade, altering metabolic functions, and causing hemodynamic shock (Yamamoto et al 2002). Serious endotoxin intoxication will cause endotoxemia (Ikeda et al 2014). Because of its toxicity, removing endotoxin from drugs and food is of great importance.…”