Abstract
BackgroundTo evaluate the prognostic value of endotoxin activity assay (EAA) in adult patients with suspected or proven severe sepsis after cardiac surgeryMethodsBlood samples taken from 81 patients immediately after the diagnosis of severe sepsis were tested with the EAA. Patients were divided into 3 groups: low (<0.4, n = 20), moderate (0.4-0.59, n = 35) and high (≥0.6, n = 26) EAA levels.ResultsGram-negative bacteraemia was found in 19/55 (35%) of cases with ЕАА <0.6 and in 11/26 (42%) of cases with higher ЕАА, p = 0.67. Mortality at 28 days in Groups 1, 2 and 3 was 20%, 43% and 54%, respectively. Patients with an EAA higher than 0.65 had a higher 28-day mortality than those with lower EAA values (18/26 – 69% vs. 19/55 – 34.5%; p = 0.0072). ROC analysis for the prediction of 28-day mortality revealed an AUC for APACHE II scores, EAA and PCT of 0.81, 0.73 and 0.66, respectively.ConclusionsEАА might be useful for recognising patients who have an increased risk of mortality due to severe sepsis.
Highlights
To evaluate the prognostic value of endotoxin activity assay (EAA) in adult patients with suspected or proven severe sepsis after cardiac surgery
There were no significant differences between survivors and non-survivors in terms of age, gender, rate of renal failure, dialysis requirement, need for inotropic support and White blood cells (WBC) count
APACHE Acute physiology and chronic health evaluation score (II) scores were significantly higher in non-survivors
Summary
To evaluate the prognostic value of endotoxin activity assay (EAA) in adult patients with suspected or proven severe sepsis after cardiac surgery. The role of endotoxin in the pathogenesis of sepsis is well-known [1]. Developing of systemic inflammatory response syndrome leads to disturbances in membrane permeability together with multiple organ dysfunction syndrome and, often, death. Quantitative techniques for the measurement of endotoxin levels in blood have been known for more than 40 years [2] and are based on the application of the LAL endotoxin assay (Limulus Amebocyte Lysate). A new method for assessing endotoxin concentration in blood has been developed – the Endotoxin Activity Assay (EAA) [3,4]. Experimental observations [4] revealed that the results of EAA testing correlate with
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