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John C. Marshall, Debra Foster, Jean-Louis Vincent, Deborah J. Cook, Jonathan Cohen, R. Phillip Dellinger, Steven Opal, Edward Abraham, Stephen J. Brett, Terry Smith, Sangeeta Mehta, Anastasia Derzko, Diagnostic and Prognostic Implications of Endotoxemia in Critical Illness: Results of the MEDIC Study, The Journal of Infectious Diseases, Volume 190, Issue 3, 1 August 2004, Pages 527–534, https://doi.org/10.1086/422254
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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 intensivecare unit (ICU). On the day of ICU admission, 57.2% of patients had either intermediate (⩾0.40 endotoxin activity [EA] units) or high (⩾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.