Maurizio Bottiroli1, Gianpaola Monti1, Riccardo Pinciroli2, Irene Vecchi1, Valeria Terzi1, Giuseppe Ortisi1, Giampaolo Casella3, Roberto Fumagalli4. 1. Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda. P.zza Ospedale Maggiore 3, 20162 Milan, Italy. 2. Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda. P.zza Ospedale Maggiore 3, 20162 Milan, Italy; University of Milan-Bicocca School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy. Electronic address: riccardo.pinciroli@unimib.it. 3. Department of Diagnostic Sciences. ASST Santi Paolo e Carlo. Via Pio II, 3. 20153 Milan, Italy. 4. Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda. P.zza Ospedale Maggiore 3, 20162 Milan, Italy; University of Milan-Bicocca School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
Abstract
PURPOSE: To measure the prevalence of elevated Endotoxin Activity (EA) in a large cohort of patients with Septic Shock (SS), and to assess its value as an early indicator of Gram-Negative (GN) infection, disease severity, and patient risk. MATERIALS AND METHODS: Adult patients were enrolled in this observational study if an EA determination was obtained within 24-h from SS onset. Demographic, clinical, and microbiological data were collected. In-hospital follow-up was also conducted. RESULTS: A high prevalence of endotoxemia was observed in the 107 subjects included, with 82% of patients showing either intermediate (≥0.4 units), or high (≥0.6) EA. Patients with positive cultures for GNs showed a higher mean EA (0.63±0.18 vs. 0.53±0.22; p<0.05). However, the test showed poor accuracy in the identification of GN bacteria as SS causative agents. Significantly higher lactate concentration (p=0.006), SOFA (p=0.04) and inotropic score (p=0.006) were observed in patients with endotoxemia. However, higher EA levels neither influenced mortality, nor length of stay. CONCLUSIONS: Early after SS onset, patients showed a high prevalence of endotoxemia, particularly those infected with GN bacteria. The EA assay might be a useful marker of disease severity. The complexity of such patients, however, limits EA accuracy in identifying GN sepsis and predicting outcome.
PURPOSE: To measure the prevalence of elevated Endotoxin Activity (EA) in a large cohort of patients with Septic Shock (SS), and to assess its value as an early indicator of Gram-Negative (GN) infection, disease severity, and patient risk. MATERIALS AND METHODS: Adult patients were enrolled in this observational study if an EA determination was obtained within 24-h from SS onset. Demographic, clinical, and microbiological data were collected. In-hospital follow-up was also conducted. RESULTS: A high prevalence of endotoxemia was observed in the 107 subjects included, with 82% of patients showing either intermediate (≥0.4 units), or high (≥0.6) EA. Patients with positive cultures for GNs showed a higher mean EA (0.63±0.18 vs. 0.53±0.22; p<0.05). However, the test showed poor accuracy in the identification of GN bacteria as SS causative agents. Significantly higher lactate concentration (p=0.006), SOFA (p=0.04) and inotropic score (p=0.006) were observed in patients with endotoxemia. However, higher EA levels neither influenced mortality, nor length of stay. CONCLUSIONS: Early after SS onset, patients showed a high prevalence of endotoxemia, particularly those infected with GN bacteria. The EA assay might be a useful marker of disease severity. The complexity of such patients, however, limits EA accuracy in identifying GN sepsis and predicting outcome.
Authors: Juan Carlos Ruiz-Rodriguez; Erika P Plata-Menchaca; Luis Chiscano-Camón; Adolfo Ruiz-Sanmartin; Marcos Pérez-Carrasco; Clara Palmada; Vicent Ribas; Mónica Martínez-Gallo; Manuel Hernández-González; Juan J Gonzalez-Lopez; Nieves Larrosa; Ricard Ferrer Journal: World J Crit Care Med Date: 2022-01-09