Endotoxemia is common following abdominal organ transplantation and is associated with reperfusion and rejection

Hilmi, Ibtesam A.; Kellum, John A.; Planinsic, Raymond M.; Foster, Debra; Abdullah, Ali; Damian, Daniela; Gligor, Silviu; Klein, David J.; Abu‐Elmagd, Kareem

doi:10.3109/17471060902859113

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…In a prospective observational study of 40 patients undergoing orthotopic liver transplantation and multi-visceral transplantation, Hilmi and colleagues [25] examined endotoxin levels during the operative phase and for up to one month following transplantation. In transplant recipients mean pre-surgical EA values were significantly higher than controls (0.21 versus 0.5, P = 0.001) and further increased upon graft reperfusion in orthotopic liver transplants ( P = 0.018).…”

Section: Japanese Experience With Eaa and Polymyxin Hemofiltration (Ementioning

confidence: 99%

Bench-to-bedside review: Clinical experience with the endotoxin activity assay

2012

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Endotoxin detection in human patients has been a difficult challenge, in part due to the fact that the conserved active portion of the molecule (lipid A) is a relatively small epitope only amenable to binding by a single ligand at any one instance and low levels (pg/ml) are capable of stimulating the immune system. The endotoxin activity assay, a bioassay based on neutrophil activation by complement opsonized immune complexes of lipopolysaccharide (LPS), has allowed the specific detection of the lipid A epitope of LPS in a rapid whole blood assay format. This review summarizes diagnostic studies utilizing the endotoxin activity assay in a variety of hospital patient populations in whom endotoxin is postulated to play a significant role in disease etiology. These include ICU patients at risk of developing 'sepsis syndrome', abdominal and cardiovascular surgery patients and patients with serious traumatic injury. Significant features of these studies include the high negative predictive value of the assay (98.6%) for rule out of Gram-negative infection, ability to risk stratify patients progressing to severe sepsis (odds ratio 3.0) and evidence of LPS release in patients with gut hypoperfusion. Preliminary studies have successfully combined the assay with anti-LPS removal strategies to prospectively identify patients who might benefit from this therapy with early evidence of clinical benefit.

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Section: Japanese Experience With Eaa and Polymyxin Hemofiltration (Ementioning

confidence: 99%

Bench-to-bedside review: Clinical experience with the endotoxin activity assay

2012

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“…Endotoxemia may arise from two sources: 1) Gramnegative infection; or 2) Translocation of bacterial products from the gastrointestinal tract [5,18,22]. This study showed that both Gram-positive infection cases and Gram-negative infection cases demonstrated significant high EA levels (Figure 3).…”

Section: Discussionmentioning

confidence: 74%

“…Endotoxin (ET), a complex lipopolysaccharide (LPS), is present in the cell wall of Gram-negative bacteria and is capable of stimulating the immune system and coagulation cascade [1,18]. A distinct carrier protein, LPS-binding protein, transports circulating ET and facilitates its recognition by the cell through a unique receptor, CD14; an associated pattern-recognition receptor, TLR4; and an accessory protein, MD2; that transduces the ET signal to the cell nucleus, leading to the expression of a complex network on inflammatory mediator [1].…”

Section: Discussionmentioning

confidence: 99%

“…Failure in early detection of sepsis causes multiple organ failure and results in high mortality. High levels of Endotoxin Activity are associated with worse clinical outcomes [18,19]. For this reason, the diagnosis of the sepsis must be given immediately and it is necessary to intervene it at the early stage of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The EAA is a rapid chemiluminescent immunodiagnostic test kit that contains labeled glass tubes of specific reagents and a container of liquid substrate. The EAA is approved by Food and Drug Administration (FDA) as a method to evaluate ET activity (EA) in whole blood because of its' high sensitivity and specificity for LPS and has demonstrated a strong clinical signal with a patient's clinical status [5,18]. The EAA measures the EA in whole blood by the priming of host neutrophil respiratory burst activeity via complement opsonized LPS-IgM complexes.…”

Section: Endotoxin Activity Assay (Eaa)mentioning

confidence: 99%

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Newly Developed Endotoxin Measurement Method (the Endotoxin Activity Assay) May Reflect the Severity of Sepsis

Ishihata¹,

Kakihana²,

Yasuda³

et al. 2013

OJPathology

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Objectives: Endotoxin (ET) is a structural molecule of the Gram-negative bacilli extracellular membrance, which activates targeted cells including macrophages and neutrophils, and causes septic shock. But it is known that the conventional ET measurement method has many problems; for example, a discrepancy between plasma ET concentration and clinical manifestration in the septic patients has been reported. The purpose of this study was to evaluate the usefulness of a newly developed method (Endotoxin Activity Assay (EAA)) to measure the ET activity (EA) in patients under sepsis compared with the prior method of the limulus amebocyte lysate (LAL) assay and explore the association between EA levels and patients' severity. Method: We measured the EA levels in 40 patients (aged 63.5 +/− 17.7 years) admitted to the ICU. EA level was measured using a chemiluminometer (Autolumat LB953; EG & Berthold). Patients were divided into 5 groups: 1) control group; 2) systemic inflammatory response syndrome (SIRS) group; 3) sepsis (SIRS and infection) group; 4) severe sepsis group and 5) septic shock group. We then compared the EA level between each group and control group. We made the statistical evaluation by unpaired t test and significant difference was p < 0.05. Results: The EA levels were significantly increased as sepsis severity rises. The measured EA levels were (0.18 +/− 0.09), (0.33 +/− 0.19), (0.39 +/− 0.16), (0.65 +/− 0.25) and (0.78 +/− 0.34) in control, SIRS, sepsis, severe sepsis and septic shock groups, respectively. In the EA level measured by EAA, severe patients had a tendency to exceed the cutoff value. Conclusion: The EA levels were significantly correlated as patients' severity rise. Measuring EA levels on admittion to ICU may provide a mechanism to identify and target severe septic patients.

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