Abstract
We studied prospectively plasma endotoxin (lipopoly-saccharides, LPS) levels in forty-five consecutively admitted patients with bacteriologically verified systemic meningococcal disease (SMD). Using a semi-automated, Limulus / chromogenic substrate test (detection limite=25 ng/L, 25 patients (56%) had detectable LPS on admission. LPS>700 ng/L seemed to be critical in developing: 1) Severe, persistent septic shock (15/15 versus 3/30) (p<0.0001). 2) Pathologically elevated serum creatinine (15/15 versus 3/30, p<0.0001), 3) Adult respiratory distress syndrom (5/15 versus 1/30, p=0.01) and 4) Dying (8/15 versus 1/30, p=0,0002, Fisher's exact test). LPS were cleared from the circulation with T/2= 1-3 hours after initiation of antibiotic therapy. Increasing LPS levels were never observed. Blood exchange or plasmapheresis did not significantly increase the LPS clearance. Conclusion: LPS quantitation is of importance as a prognostic marker in meningococcal infections
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