Endotoxin activity levels as a prediction tool for risk of deterioration in patients with sepsis not admitted to the intensive care unit: A pilot observational study |
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Authors: | Emanuela Biagioni MD Claudia Venturelli David J. Klein Marta Buoncristiano Fabio Rumpianesi Stefano Busani Laura Rinaldi Abele Donati Massimo Girardis |
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Affiliation: | 1. Anaesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41100 Modena, Italy;2. Microbiological Unit, University Hospital of Modena, L.go del Pozzo 71, 41100 Modena, Italy;3. Department of Critical Care and the Keenan Research Center of the Li Ka Shing Knowledge Institute, St Michael''s Hospital, University of Toronto, Toronto, Canada;4. Anaesthesia and Intensive Care Unit, University Hospital of Ancona and Università Politecnica delle Marche, 60020 Torrette di Ancona, Ancona, Italy |
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Abstract: | PurposeThe aim of this prospective observational study was to evaluate in patients with sepsis not requiring intensive care unit admission the relationship between the levels of endotoxin activity assay (EAA) early after sepsis recognition and the risk of development of organ dysfunction (OD).MethodsEndotoxin activity assay levels were drawn immediately after sepsis identification (baseline) and at 6, 24, and 48 hours postbaseline in 50 patients with signs of sepsis of a duration of less than 24 hours. An EAA 0.60 units or greater was considered as highly elevated.ResultsLogistic regression showed independent association between EAA levels at baseline and the appearance of new OD (adjusted odd ratio, 2.41; 95% confidence interval, 1.18-4.90; P < .05). Fifteen patients (30%) who developed new OD after baseline had at least 1 EAA level 0.60 or greater. The adjusted linear regression analysis showed that across the 4 time points, EAA levels were significantly higher in patients who developed new OD (0.11; 95% confidence interval, 0.01-0.20; P < .05).ConclusionsEndotoxin activity assay levels 0.60 or greater early after sepsis diagnosis in patients not requiring intensive care unit admission predict risk of development of new organ dysfunction. High EAA levels in the first 48 hours of recognition of sepsis are also predictive of risk of deterioration. |
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Keywords: | Severe sepsis Shock Endotoxin Organ dysfunction Intensive care unit Infection |
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