Limulus Amebocyte Lysate Assay for Detection of Endotoxin in Patients with Sepsis Syndrome

Abstract

Clinical predictions alone are insufficiently accurate to identify patients with specific types of bloodstream infection; laboratory assays might improve such predictions. Therefore, we performed a prospective cohort study of 356 episodes of sepsis syndrome and did Limulus amebocyte lysate (LAL) assays for endotoxin. The main outcome measures were bacteremia and infection due to gram-negative organisms; other types of infection were secondary outcomes. Assays were defined as positive if the result was > or = 0.4 enzyme-linked immunosorbent assay units per milliliter. There were positive assays in 119 (33%) of 356 episodes. Assay positivity correlated with the presence of fungal bloodstream infection (P < .003) but correlated negatively with the presence of gram-negative organisms in the bloodstream (P = .04). A trend toward higher rates of mortality in the LAL assay-positive episodes was no longer present after adjusting for severity. Thus, results of LAL assay did not correlate with the presence of bacteremia due to gram-negative organisms or with mortality after adjusting for severity but did correlate with the presence of fungal bloodstream infection.

Quantitative lipopolysaccharide analysis using HPLC/MS/MS and its combination with the limulus amebocyte lysate assay

“…Even though the LAL assay has been used in most studies dealing with endotoxemia measurement, it has repeatedly been reported to be negative in some patients with sepsis ( 32,33 ), and not to be clinically useful for detecting Gram-negative infections or predicting patient outcomes ( 16,34,35 ). Surprisingly, earlier studies reported that LAL positivity was observed in only 20% of patients presenting …”

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“…The remaining very ill patients had serial blood and other relevant cultures performed, but no causative agent was found. However, it is possible that some of these patients had endotoxemia as the underlying cause of disease [21].…”

Recombinant Bactericidal/Permeability‐Increasing Protein (rBPI21) for Treatment of Parvovirus Enteritis: A Randomized, Double‐Blinded, Placebo‐Controlled Trial

“…22,23 Endotoxemia has been correlated with prognosis in dogs with pyometra, 24 and there was a trend for endotoxin to be correlated with outcome in CPV, 4 but endotoxin in circulation may be transient or circulating inhibitors may interfere with measurement. 25,26 Endotoxin can be difficult to measure, 26 and the method used for this study was different from that used previously.…”