Diagnostic and prognostic implications of endotoxemia in critical illness: results of the MEDIC study. Academic Article uri icon

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abstract

  • A novel assay for endotoxin, based on the ability of antigen-antibody complexes to prime neutrophils for an augmented respiratory burst response, was studied in a cohort study of 857 patients admitted to an intensive-care unit (ICU). On the day of ICU admission, 57.2% of patients had either intermediate (>or=0.40 endotoxin activity [EA] units) or high (>or=0.60 units) EA levels. Gram-negative infection was present in 1.4% of patients with low EA levels, 4.9% with intermediate levels, and 6.9% with high levels; EA had a sensitivity of 85.3% and a specificity of 44.0% for the diagnosis of gram-negative infection. Rates of severe sepsis were 4.9%, 9.2%, and 13.2%, and ICU mortality was 10.9%, 13.2%, and 16.8% for patients with low, intermediate, and high EA levels, respectively. Stepwise logistic regression analysis showed that elevated Acute Physiology and Chronic Health Evaluation II score, gram-negative infection, and emergency admission status were independent predictors of EA.

authors

  • Marshall, John C
  • Foster, Debra
  • Vincent, Jean-Louis
  • Cook, Deborah
  • Cohen, Jonathan
  • Dellinger, R Phillip
  • Opal, Steven
  • Abraham, Edward
  • Brett, Stephen J
  • Smith, Terry
  • Mehta, Sangeeta
  • Derzko, Anastasia
  • Romaschin, Alex
  • MEDIC study

publication date

  • August 1, 2004

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